Van Den Puttelaar Rosita, Shi Kewei Sylvia, Smith Robert, Zhao Jingxuan, Ogongo Margaret Katana, Harlass Matthias, Hahn Anne I, Zauber Ann G, Yabroff K Robin, Lansdorp-Vogelaar Iris
Department of Public Health, Erasmus University Medical Center, 3015GD Rotterdam, The Netherlands.
Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA 30303, USA.
J Natl Cancer Inst. 2025 Apr 1;117(4):790-794. doi: 10.1093/jnci/djae244.
The Affordable Care Act (ACA) eliminated patient cost-sharing for United States Preventive Service Task Force (USPSTF) recommended services. However, if the US Court of Appeals for the Fifth Circuit fully upheld a US District Court ruling in Braidwood Management v. Becerra, 666 F. Supp. 3d 613 (N.D. Tex 2023), cost-sharing for USPSTF recommendations made after ACA passage would have been reinstated for more than 150 million people. The case would have reinstated cost-sharing for colorectal cancer (CRC) screening for ages 45-49 years and for polyp removal during (diagnostic) colonoscopy across all ages. Using the MISCAN-Colon model, we simulated the potential impact on CRC outcomes, assuming early-onset CRC trends and lower screening participation. An 8-percentage-point decline in screening participation could increase CRC incidence by 5.1% and CRC mortality by 9.1%, with slightly lower costs due to increased cost-sharing. Larger decreases in screening participation can result in higher costs from increased incidence and delayed diagnoses.
《平价医疗法案》（ACA）取消了美国预防服务工作组（USPSTF）推荐服务的患者费用分摊。然而，如果美国第五巡回上诉法院完全维持美国地方法院在Braidwood Management v. Becerra案（666 F. Supp. 3d 613，德克萨斯北区，2023年）中的裁决，那么《平价医疗法案》通过后USPSTF建议的费用分摊将恢复，涉及超过1.5亿人。该案件将恢复45至49岁人群的结直肠癌（CRC）筛查费用分摊，以及所有年龄段在（诊断性）结肠镜检查期间切除息肉的费用分摊。使用MISCAN - 结肠模型，我们模拟了对CRC结局的潜在影响，假设早发性CRC趋势和较低的筛查参与率。筛查参与率下降8个百分点可能会使CRC发病率增加5.1%，CRC死亡率增加9.1%，由于费用分摊增加，成本略有降低。筛查参与率的更大降幅可能会因发病率增加和诊断延迟而导致更高的成本。
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