Breast Cancer Population Screening Program Results in Early Detection and Reduced Treatment and Health Care Costs for Medicaid

Abstract

Context: The National Breast and Cervical Cancer Early Detection Program has increased access to screening services for low-income females since 1991; however, evaluation information from states implementing the program is sparse. This study evaluates the impact of the Missouri program, Show Me Healthy Women (SMHW), on early detection and treatment cost. Objective: To estimate breast cancer treatment and health care services costs by stage at diagnosis among Missouri's Medicaid beneficiaries and assess the SMHW program impact. Design: Analyzed Missouri Medicaid claims linked with Missouri Cancer Registry data for cases diagnosed 2008-2012 (N = 1388) to obtain unadjusted and incremental costs of female breast cancer treatment and follow-up care at 6, 12, and 24 months following diagnosis. Noncancer controls (N = 3840) were matched on age, race, and disability to determine usual health care cost. Regression analyses estimated the impact of stage at diagnosis on expenditures and incremental cost. Show Me Healthy Women participants were compared with other breast cancer patients on stage at diagnosis. A comparison of SMHW participants to themselves had they not been enrolled in the program was analyzed to determine cost savings. Results: Expenditures increased by stage at diagnosis from in situ to distant with unadjusted cost at 24 months ranging from $50 245 for in situ cancers to $152 431 for distant cancers. Incremental costs increased by stage at diagnosis from 6 months at $7346, $11 859, $21 501, and $20 235 for in situ, localized, regional, and distant breast cancers, respectively, to $9728, $17 056, $38 840, and $44 409 at 24 months. A significantly higher proportion of SMHW participants were diagnosed at an early stage resulting in lower unadjusted expenditures and cost savings. Conclusions: Although breast cancer treatment costs increased by stage at diagnosis, the population screening program's significant impact on early diagnosis resulted in important cost savings over time for Medicaid.

Association of Endocrine Therapy Initiation Timeliness With Adherence and Continuation in Low-Income Women With Breast Cancer

“…Following the data collection and coding guidelines developed by the National Program of Cancer Registries, the Missouri Cancer Registry collects the diagnostic (date of diagnosis, primary site, cancer stage, tumor grade, tumor size, and HR status), treatment (dates of definitive surgery, first radiotherapy, first chemotherapy, and first hormone therapy prescription), and demographic (race, ethnicity, age, marital status, sex, and census tract) information for more than 95% of all incident cases of cancer in Missouri. A probabilistic matching approach was used, and matching variables included unique departmental control numbers, first and last name, social security number, date of birth, and race and ethnicity . The study was approved by the institutional review board at Washington University School of Medicine in St. Louis, the Missouri Department of Health and Senior Services, and the Missouri Department of Social Services with a waiver of consent granted for the use of deidentified data.…”

“…A probabilistic matching approach was used, and matching variables included unique departmental control numbers, first and last name, social security number, date of birth, and race and ethnicity. 22,23 The study was approved by the institutional review board at Washington University School of Medicine in St. Louis, the Missouri Department of Health and Senior Services, and the Missouri Department of Social Services…”

Timing of Medicaid Enrollment, Late-Stage Breast Cancer Diagnosis, Treatment Delays, and Mortality

“…Following the data collection and coding rules set by the National Program of Cancer Registries, the Missouri Cancer Registry collects data on demographic factors (race, ethnicity, age, marital status, sex), address at time of diagnosis, tumor characteristics (date of diagnosis, primary site, tumor grade, tumor size), and tumor-directed treatment modalities (surgery, radiotherapy, chemotherapy, and hormone therapy) and their start dates for more than 95% of incident cases in Missouri. A probabilistic matching approach was used, and matching variables included unique departmental control numbers, first and last name, social security number, date of birth, and race or ethnicity ( 22 ). The study was approved by the institutional review board at Washington University School of Medicine in St. Louis, the Missouri Department of Health and Senior Services, and the Missouri Department of Social Services.…”

Toward the strengthening of radioprotection during mammography examinations through transparent glass screens: A benchmarking between experimental and Monte Carlo simulation studies

“…Due to its high prevalence and mortality rate among women, breast cancer has a prominent position among the many types of cancers (2). Scientific reports indicate that breast cancer is more manageable if detected at an earlier stage through breast screening programs (3). This is because the most significant tool for early diagnosis is breast screening (4), which is conducted using a variety of systematic methods, including mammography devices (4).…”