Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

High Medicare spending on prostate cancer screenings, but little benefit for older men

04.10.2013
Prostate cancer screening has little benefit for men aged 75 and older, yet over three years, the Medicare fee-for-service program spent $447 million annually on PSA-based screenings—one-third of which was for men in the over 75 age group, according to study by researchers at the Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center.

Published in the Oct. 4 issue of the journal Cancer, the study also found considerable geographic variation in the cost of prostate cancer screening.

Many prostate cancers are slow-growing and unlikely to become problematic. Widespread screening with a serum-based PSA test may result in unnecessary invasive biopsies, which can be a physical burden or even harmful. In 2012, the U.S. Preventative Services Task Force decided to stop recommending PSA screening for men of any age. Medicare, however, continues to reimburse for this test and the subsequent procedures.

Lead author Xiaomei Ma, associate professor at Yale School of Public Health, and her Yale COPPER Center colleagues conducted an observational study of older male Medicare beneficiaries who were free of prostate cancer and other lower urinary tract symptoms at the end of 2006, and followed them for three years.

In addition to large Medicare spending for prostate cancer screening in older men, the team found that the costs of prostate cancer screening ranged considerably from $17 to $62 per beneficiary across regions. The bulk of this variation was not due to the cost of PSA test itself, but rather to variation in costs of the follow-up tests across regions.

“More than 70% of prostate cancer screening-related costs were due to follow-up procedures,” said Ma, who is also a member of the Yale Cancer Center. “Our results suggest that the overall cost of prostate cancer screening may be heavily influenced by how urologists choose to respond to the result of a PSA test, more so than the use of the PSA itself.”

Meanwhile, the benefits of screening and treatment are not clear. While men living in high-spending regions were more likely to be diagnosed with localized cancers, they were not significantly less likely to be diagnosed with metastatic cancer. This suggests that spending more on prostate cancer screening might identify more localized tumors, but may not necessarily reduce the rate of metastatic cancers.

“In terms of what these results mean for Medicare spending, this is just the tip of the iceberg,” said Cary Gross, M.D., professor of internal medicine at Yale School of Medicine, and director of the Yale COPPER Center. “Many older men who are diagnosed with early-stage prostate cancer may end up receiving therapy that is potentially toxic, has little chance of benefit, and carries substantial cost. In order to truly understand the costs of screening, the next step is to identify how many additional cancers are being diagnosed and treated as a result of screening older men for prostate cancer. We need better tools to target screening efforts towards those who are likely to benefit.”

“In a time when healthcare spending is soaring, it is important to weigh the physical, psychological, and financial burden of cancer screening against the possible clinical benefit,” said Gross, who is a member of the Yale Cancer Center. “The cancer research community needs to continue exploring novel approaches to target prostate cancer screening and treatment efforts, identifying and disseminating strategies that work, and abandoning strategies that don’t work.”

Other authors on the study include Rong Wang, Jessica B. Long, Joseph S. Ross, M.D., Pamela R. Soulos, James B. Yu, M.D., Danil V. Makarov, M.D., and Heather T. Gold.

The study was supported in part by the National Cancer Institute, the National Institute on Aging, the American Federation for Aging Research through the Paul B. Beeson Career Development Award Program, the Centers of Medicare and Medicaid Services, the Pew Charitable Trusts, and the Yale Clinical and Translational Science Award grant from the National Center for Advancing Translational Sciences at the National Institutes of Health.

Citation: Cancer doi: 10.1002/cncr.28373 (Oct. 4, 2013)

Karen N. Peart | EurekAlert!
Further information:
http://www.yale.edu

More articles from Studies and Analyses:

nachricht Win-win strategies for climate and food security
02.10.2017 | International Institute for Applied Systems Analysis (IIASA)

nachricht The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Salmonella as a tumour medication

HZI researchers developed a bacterial strain that can be used in cancer therapy

Salmonellae are dangerous pathogens that enter the body via contaminated food and can cause severe infections. But these bacteria are also known to target...

Im Focus: Neutron star merger directly observed for the first time

University of Maryland researchers contribute to historic detection of gravitational waves and light created by event

On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...

Im Focus: Breaking: the first light from two neutron stars merging

Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.

Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....

Im Focus: Smart sensors for efficient processes

Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).

When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...

Im Focus: Cold molecules on collision course

Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.

How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

3rd Symposium on Driving Simulation

23.10.2017 | Event News

ASEAN Member States discuss the future role of renewable energy

17.10.2017 | Event News

World Health Summit 2017: International experts set the course for the future of Global Health

10.10.2017 | Event News

 
Latest News

Single nanoparticle mapping paves the way for better nanotechnology

24.10.2017 | Physics and Astronomy

A quantum spin liquid

24.10.2017 | Physics and Astronomy

Antibiotic resistance: a strain of multidrug-resistant Escherichia coli is on the rise

24.10.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>