Florence K. Tangka

Reported drop in mammography : is this cause for concern?

Timely screening with mammography can prevent a substantial number of deaths from breast cancer. The objective of this brief was to ascertain whether recent use of mammography has dropped nationally.

Disparities in mammography use among US women aged 40-64 years, by race, ethnicity, income, and health insurance status, 1993 and 2005.

Objective:To examine current disparities in mammography use, and changes in disparities over time by race, ethnicity, income, insurance, and combinations of these characteristics. Research Design:Comparison of cross-sectional surveys of mammography use using the 1993 and 2005 National Health Interview Survey. Subjects:Women aged 40–64 (1993, n = 4167; 2005, n = 7434). Measures:Mammogram within prior 2 years. Results:In 2005, uninsured women reported the lowest mammography use (38.3%). Though screening increased 6.9 percentage points among low-income, uninsured women, the overall disparity between insured and uninsured women did not change significantly between 1993 and 2005. Screening seems to have declined among middle-income, uninsured women, increasing the gap compared with middle-income, insured women. The lower mammography use in 1993 among American Indian/Alaska Native compared with white women was not present in 2005; however, lower use among Asian compared with white women emerged in 2005. We found no differences between African American and white women. Hispanic women were less likely than non-Hispanic women to report screening in 2005 (58.1% vs. 69.0%). Conclusions:Although mammography use increased for some groups between 1993 and 2005, low-income, uninsured women continued to have the lowest screening rates in 2005 and the disparity for this group was not reduced. The gap in screening use for middle-income, uninsured women increased, resulting from possible declines in mammography even for uninsured women not in poverty. Asian women became less likely to receive screening in 2005. Continuing efforts are needed to eliminate disparities. Increased efforts are especially needed to address the large persistent disparity for uninsured women, including middle-income uninsured women.

The Economic Burden of Chronic Cardiovascular Disease for Major Insurers

Accounting models provide less precise estimates of disease burden than do econometric models. The authors seek to improve these estimates for cardiovascular disease using a nationally representative survey and econometric modeling to isolate the proportion of medical expenditures attributable to four chronic cardiovascular diseases: stroke, hypertension, congestive heart failure, and other heart diseases. Approximately 17% of all medical expenditures, or

Cancer treatment cost in the United States: has the burden shifted over time:

149 billion annually, and nearly 30% of Medicare expenditures are attributable to these diseases. Of the four diseases, hypertension accounts for the largest share of prescription expenditures across payers and the largest share of all Medicaid expenditures. The large number of people with cardiovascular disease who are eligible for both Medicare and Medicaid could lead to large shifts in the burden to these payers as prescription drug coverage is included in Medicare. A societal perspective is important when describing the economic burden of cardiovascular disease.

Data and trends in cancer screening in the United States: results from the 2005 National Health Interview Survey.

There has not been a comprehensive analysis of how aggregate cancer costs have changed over time. The authors present 1) updated estimates of the prevalence and total cost of cancer for select payers and how these have changed over the past 2 decades; and 2) for each payer, the distribution of payments by type of service over time to assess whether there have been shifts in cancer treatment settings.

Melanoma Treatment Costs: A Systematic Review of the Literature, 1990–2011

This paper examines the prevalence of cancer screening use as reported in 2005 among US adults, focusing on differences among historically underserved subgroups. We also examine trends from 1992 through 2005 to determine whether differences in screening use are increasing, staying the same, or decreasing.

Cost Analysis of the National Breast and Cervical Cancer Early Detection Program : Selected States, 2003 to 2004

CONTEXT Melanoma is the most deadly form of skin cancer and an important public health concern. Given the substantial health burden associated with melanoma, it is important to examine the economic costs associated with its treatment. The purpose of the current study was to systematically review the literature on the direct medical care costs of melanoma. EVIDENCE ACQUISITION A systematic review was performed using multiple databases including MEDLINE, Embase, CINAHL, and Econlit. Nineteen articles on the direct medical costs of melanoma were identified. EVIDENCE SYNTHESIS Detailed information on the study population, study country/setting, study perspective, costing approach, disease severity (stage), and key study results were abstracted. The overall costs of melanoma were examined as well as per-patient costs, costs by phase of care, stage of diagnosis, and setting/type of care. Among studies examining all stages of melanoma, annual treatment costs ranged from

Patterns and Trends in Cancer Screening in the United States

44.9 million among Medicare patients with existing cases to

Clinical outcomes from the CDC's Colorectal Cancer Screening Demonstration Program

932.5 million among newly diagnosed cases across all age groups. CONCLUSIONS Melanoma leads to substantial direct medical care costs, with estimates varying widely because of the heterogeneity across studies in terms of the study setting, populations studied, costing approach, and study methods. Melanoma treatment costs varied by phase of care and stage at diagnoses; costs were highest among patients diagnosed with late-stage disease and in the initial and terminal phases of care. Aggregate treatment costs were generally highest in the outpatient/office-based setting; per-patient/per-case treatment costs were highest in the hospital inpatient setting. Given the substantial costs of treating melanoma, public health strategies should include efforts to enhance both primary prevention (reduction of ultraviolet light exposure) and secondary prevention (earlier detection) of melanoma.

Cost analysis of the national breast and cervical cancer early detection program - Selected states, 2003 to 2004: Selected States 2003-2004

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was established by the U.S. Congress in 1990. In recent years, there has been an emphasis on ascertaining the NBCCEDPs costs of delivering screening and diagnostic services to medically underserved, low‐income women. The objective of this report was to address 3 economic questions: What is the cost per woman served in the program, what is the cost per woman served by program component, and what is the cost per cancer detected through the program?