David W. Lee

The Sharp Slowdown In Growth Of Medical Imaging: An Early Analysis Suggests Combination Of Policies Was The Cause

The growth in the use of advanced imaging for Medicare beneficiaries decelerated in 2006 and 2007, ending a decade of growth that had exceeded 6 percent annually. The slowdown raises three questions. Did the slowdown in growth of imaging under Medicare persist and extend to the non-Medicare insured? What factors caused the slowdown? Was the slowdown good or bad for patients? Using claims file data and interviews with health care professionals, we found that the growth of imaging use among both Medicare beneficiaries and the non-Medicare insured slowed to 1-3 percent per year through 2009. One by-product of this deceleration in imaging growth was a weaker market for radiologists, who until recently could demand top salaries. The expansion of prior authorization, increased cost sharing, and other policies appear to have contributed to the slowdown. A meaningful fraction of the reduction in use involved imaging studies previously identified as having unproven medical value. What has occurred in the imaging field suggests incentive-based cost control measures can be a useful complement to comparative effectiveness research when a procedures ultimate clinical benefit is uncertain.

Lifetime and Treatment-Phase Costs Associated With Colorectal Cancer: Evidence from SEER-Medicare Data

BACKGROUND & AIMS This study provides detailed estimates of lifetime and phase-specific colorectal cancer (CRC) treatment costs. METHODS This retrospective cohort study included patients aged 66 years and older, newly diagnosed with CRC in a Surveillance Epidemiology and End Results (SEER) registry (1996-2002), matched 1:1 (by age, sex, and geographic region) to patients without cancer from a 5% sample of Medicare beneficiaries. The Kaplan-Meier sample average estimator was used to estimate observed 10-year costs, which then were extrapolated to 25 years. A secondary analysis computed costs on a per-survival-year basis to adjust for differences in mortality by stage and age. Costs were expressed in 2006 US

The direct and indirect cost burden of clinically significant and symptomatic uterine fibroids

, with future costs discounted 3% per year. RESULTS Our sample included 56,838 CRC patients (41,256 colon cancer [CC] patients and 15,582 rectal cancer [RC] patients; mean +/- SD age, 77.7 +/- 7.1 y; 55% women; and 86% white). Lifetime excess costs were

Cost-effectiveness of magnetic resonance guided focused ultrasound for the treatment of uterine fibroids

29,500 for CC and

A Framework for Assessing the Value of Diagnostic Imaging in the Era of Comparative Effectiveness Research

26,500 for RC patients. Per survival year, stage IV CRC patients incurred

Comparative analysis of Medicare spending for medical imaging: sustained dramatic slowdown compared with other services.

31,000 in excess costs compared with

National trends in advanced outpatient diagnostic imaging utilization: an analysis of the medical expenditure panel survey, 2000-2009

3000 for stage 0 patients. CRC patients incurred excess costs of

What are the total costs of surgical treatment for uterine fibroids

33,500 in the initial phase,

Factors associated with improved survival among older colorectal cancer patients in the US: a population-based analysis

4500/y in the continuing phase, and

Willingness to Pay for Diagnostic Technologies: A Review of the Contingent Valuation Literature

14,500 in the terminal phase. RC patients had lower costs than CC patients in the initial phase, but higher costs in both the continuing and terminal phases. CONCLUSIONS Excess costs associated with CRC are striking and vary considerably by treatment phase, cancer subsite, and stage at diagnosis. Interventions aimed at earlier diagnosis and prevention have the potential to reduce cancer-related health care costs.