Year: 2013
Type: article
Study design: Observational Study
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.
Source: Cancer
DOI: 10.1002/cncr.28373
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: California Department of Public Health, University of Southern California, National Institutes of Health, Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services, U.S. Public Health Service, National Institute on Aging, National Cancer Institute, National Center for Research Resources
Awards: G121795637, G1392909379, G148522456, G1883905839, G1932976417, #14: Residual Tissue Repository to Create HIV Cancer Tumor Tissue Microrarrays , G2348368848, Impact of Publicity Reporting Hospital Outcome Measures for Older Adults, G2612351997, G3409930413, G3509688676, Use and Outcomes of Radiation Therapy for Medicare Patients with Common Cancers, G4153942599, G4636760173, Yale University Clinical and Translational Science Award Program, G529197361, G6050584259, G7278087418, G7507271246, G760599220, G799849773, Rapid Response Surveillance Study #09-5 - Constructing Geographic Areas in GIS fo, G8315287662, G8385479707, G87246893, Cancer Center Support Grant
OpenAlex ID: W1678840505