The cost implications of prostate cancer screening in the Medicare population

Authors

  • Xiaomei Ma PhD,

    Corresponding author
    1. Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
    2. Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, Connecticut
    • Corresponding author: Xiaomei Ma, PhD, Yale University School of Medicine, 60 College Street, PO Box 208034, New Haven, CT 06520-8034; Fax: (203) 785-6980; xiaomei.ma@yale.edu

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  • Rong Wang PhD,

    1. Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
    2. Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, Connecticut
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  • Jessica B. Long MPH,

    1. Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, Connecticut
    2. Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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  • Joseph S. Ross MD, MHS,

    1. Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, Connecticut
    2. Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
    3. Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
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  • Pamela R. Soulos MPH,

    1. Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, Connecticut
    2. Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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  • James B. Yu MD,

    1. Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, Connecticut
    2. Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
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  • Danil V. Makarov MD, MHS,

    1. Departments of Urology and Population Sciences, New York University Langone Medical Center, New York University; Department of Urology and Nephrology Section, New York Harbor Veterans Affairs Healthcare System, New York, New York
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  • Heather T. Gold PhD,

    1. Departments of Population Health and Medicine, New York University School of Medicine and New York University Cancer Institute, New York, New York
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  • Cary P. Gross MD

    1. Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, Connecticut
    2. Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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  • We thank Dr. Stacy Loeb for sharing codes for the identification of hospitalizations due to complications of prostate biopsy.

  • The collection of the California cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute (NCI) Surveillance, Epidemiology and End Results (SEER) Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention's National Program of Cancer Registries, under agreement #U55/CCR921930-02 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health, the NCI, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, Centers for Medicare and Medicaid Services; Information Management Services, Inc.; and the SEER Program tumor registries in the creation of the SEER-Medicare database. The interpretation and reporting of the SEER-Medicare data are the sole responsibility of the authors.

Abstract

BACKGROUND

Recent debate about prostate-specific antigen (PSA)-based testing for prostate cancer screening among older men has rarely considered the cost of screening.

METHODS

A population-based cohort of male Medicare beneficiaries aged 66 to 99 years, who had never been diagnosed with prostate cancer at the end of 2006 (n = 94,652), was assembled, and they were followed for 3 years to assess the cost of PSA screening and downstream procedures (biopsy, pathologic analysis, and hospitalization due to biopsy complications) at both the national and the hospital referral region (HRR) level.

RESULTS

Approximately 51.2% of men received PSA screening tests during the 3-year period, with 2.9% undergoing biopsy. The annual expenditures on prostate cancer screening by the national fee-for-service Medicare program were $447 million in 2009 US dollars. The mean annual screening cost at the HRR level ranged from $17 to $62 per beneficiary. Downstream biopsy-related procedures accounted for 72% of the overall screening costs and varied significantly across regions. Compared with men residing in HRRs that were in the lowest quartile for screening expenditures, men living in the highest HRR quartile were significantly more likely to be diagnosed with prostate cancer of any stage (incidence rate ratio [IRR] = 1.20, 95% confidence interval [CI] = 1.07-1.35) and localized cancer (IRR = 1.30, 95% CI = 1.15-1.47). The IRR for regional/metastasized cancer was also elevated, although not statistically significant (IRR = 1.31, 95% CI = 0.81-2.11).

CONCLUSIONS

Medicare prostate cancer screening–related expenditures are substantial, vary considerably across regions, and are positively associated with rates of cancer diagnosis. Cancer 2014;120:96–102. © 2013 American Cancer Society.

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