K.A. Troeger

Cost effectiveness of endometrial ablation with the NovaSure ® system versus other global ablation modalities and hysterectomy for treatment of abnormal uterine bleeding: US commercial and Medicaid payer perspectives

Objectives Abnormal uterine bleeding (AUB) interferes with physical, emotional, and social well-being, impacting the quality of life of more than 10 million women in the USA. Hysterectomy, the most common surgical treatment of AUB, has significant morbidity, low mortality, long recovery, and high associated health care costs. Global endometrial ablation (GEA) provides a surgical alternative with reduced morbidity, cost, and recovery time. The NovaSure® system utilizes unique radiofrequency impedance-based GEA technology. This study evaluated cost effectiveness of AUB treatment with NovaSure ablation versus other GEA modalities and versus hysterectomy from the US commercial and Medicaid payer perspectives. Methods A health state transition (semi-Markov) model was developed using epidemiologic, clinical, and economic data from commercial and Medicaid claims database analyses, supplemented by published literature. Three hypothetical cohorts of women receiving AUB interventions were simulated over 1-, 3-, and 5-year horizons to evaluate clinical and economic outcomes for NovaSure, other GEA modalities, and hysterectomy. Results Model analyses show lower costs for NovaSure-treated patients than for those treated with other GEA modalities or hysterectomy over all time frames under commercial payer and Medicaid perspectives. By Year 3, cost savings versus other GEA were

Value Analysis of Digital Breast Tomosynthesis for Breast Cancer Screening in a US Medicaid Population

930 (commercial) and

Utilization of fetal fibronectin testing and pregnancy outcomes among women with symptoms of preterm labor

3,000 (Medicaid); cost savings versus hysterectomy were

404: Utilization of fetal fibronectin testing and timing of delivery among emergency department admissions with symptoms of preterm labor

6,500 (commercial) and

Employer-Perspective Cost Comparison of Surgical Treatments for Abnormal Uterine Bleeding

8,900 (Medicaid). Coinciding with a 43%–71% reduction in need for re-ablation, there were 69%–88% fewer intervention/reintervention complications for NovaSure-treated patients versus other GEA modalities, and 82%–91% fewer versus hysterectomy. Furthermore, NovaSure-treated patients had fewer days of work absence and short-term disability. Cost-effectiveness metrics showed NovaSure treatment as economically dominant over other GEA modalities in all circumstances. With few exceptions, similar results were shown for NovaSure treatment versus hysterectomy. Conclusion Model results demonstrate strong financial favorability for NovaSure ablation versus other GEA modalities and hysterectomy from commercial and Medicaid payer perspectives. Results will interest clinicians, health care payers, and self-insured employers striving for cost-effective AUB treatments.

Comparative Costs of Dense Breast Cancer Screening and Recall: Tomosynthesis vs. Ultrasound

PURPOSE Better understanding regarding the clinical-economic value of digital breast tomosynthesis (DBT) for breast cancer screening for Medicaid enrollees is needed to help inform sound, value-based decision making. The objective of this study was to conduct a clinical-economic value analysis of DBT for breast cancer screening among women enrolled in Medicaid to assess the potential clinical benefits, associated expenditures, and net budget impact of DBT. METHODS Two annual screening mammography scenarios were evaluated with an economic model: (1) full-field digital mammography and (2) combined full-field digital mammography and DBT. The model focused on two main drivers of DBT value: (1) capacity for DBT to reduce the number of women recalled for additional follow-up imaging and diagnostic services and (2) capacity of DBT to facilitate earlier diagnosis of cancer at earlier stages, when treatment costs are lower. RESULTS Model analysis results showed that the use of DBT as a mammographic screening modality by Medicaid enrollees potentially reduces the need for follow-up diagnostic services and improves the detection of invasive cancers, allowing earlier, less costly treatment. With the modest incremental reimbursement of

Utilization of TVUS and fFN Screening, Antenatal Steroids Use and Risk of Preterm Delivery [11H]

37 for DBT expected for a typical Medicaid claim, annual cost savings from DBT predicted by the model amounts to

What Costs do Employers Bear for Surgical Treatment of Abnormal Uterine Bleeding

8.14 per patient, potentially translating into more than

Evaluating Prior Pap Screening Intervals Among Women With Newly Diagnosed Cervical Cancer

12,000 savings per year for an average-sized Medicaid plan and as much as

356 Clinical and Economic Benefits of Cervical Cancer Cotesting With Three- and Five-Year Intervals

207,000 savings per year for a typical state Medicaid program. CONCLUSIONS Wider adoption of DBT presents an opportunity to deliver value-based care to Medicaid programs and to help address disparities and barriers to accessing preventive care by some of the nations most vulnerable citizens.