2013年1月8日 訊 /生物谷BIOON/ --近日,，刊登在國際雜志JAMA Internal Medicine上的一篇研究報(bào)告中，來自耶魯大學(xué)醫(yī)學(xué)院的研究者表示,，盡管醫(yī)療保險(xiǎn)每年在乳腺癌篩查中花費(fèi)了將近10億美金,，比如進(jìn)行乳房x線攝影術(shù)等，但是并沒有證據(jù)顯示,，高額的花費(fèi)會(huì)給乳腺癌患者帶來福利或者對患者受益,。
這項(xiàng)研究中研究者旨在幫助大眾理解乳腺癌掃描篩查、相關(guān)療法以及乳腺癌的花費(fèi)開支等情況,，研究者對2006年之前沒有患上乳腺癌的137,，274名女性進(jìn)行乳腺癌篩查和相應(yīng)療法的開銷進(jìn)行了評估計(jì)算，并且對這些參與者進(jìn)行兩年時(shí)間的跟蹤調(diào)查,，來掌握其乳腺癌篩查,、乳腺癌發(fā)病率及其相關(guān)的開支情況,。
研究小組發(fā)現(xiàn)，因地理區(qū)域的不同,，乳腺癌篩查所花費(fèi)的錢在每位40美元到110美元不等,，差別主要取決于篩查技術(shù)的差異。研究者Gross說,，盡管乳腺癌篩查因不同地理區(qū)域變化在兩倍以上,，但是并沒有證據(jù)揭示高額的花費(fèi)對于高花費(fèi)地區(qū)婦女的生活質(zhì)量或者生存質(zhì)量有明顯改善。
目前并沒有充足的證據(jù)揭示,，對于75歲以上婦女來說,，乳腺癌篩查是否有效，而且研究者也發(fā)現(xiàn)在這個(gè)年齡段的婦女中,，每年進(jìn)行篩查所花費(fèi)的金錢為4億美元,。
研究者需要進(jìn)行深入分析研究來揭示婦女是否可以從篩查中獲益，并且確定乳腺癌篩查是否的確有效,，在某些案例中,，乳腺癌篩查技術(shù)可以挽救個(gè)人的生命，但是并沒有人會(huì)愿意接受一種不能使其獲益,，反而對機(jī)體產(chǎn)生有害影響的技術(shù),，相關(guān)研究由國立癌癥中心等機(jī)構(gòu)提供資助。
doi:10.1001/jamainternmed.2013.1397
PMC:
PMID:
The Cost of Breast Cancer Screening in the Medicare Population
Cary P. Gross, MD; Jessica B. Long, MPH; Joseph S. Ross, MD, MHS; Maysa M. Abu-Khalaf, MD; Rong Wang, PhD; Brigid K. Killelea, MD, MPH; Heather T. Gold, PhD; Anees B. Chagpar, MD, MA, MPH, MSc; Xiaomei Ma, PhD
Background Little is known about the cost to Medicare of breast cancer screening or whether regional-level screening expenditures are associated with cancer stage at diagnosis or treatment costs, particularly because newer breast cancer screening technologies, like digital mammography and computer-aided detection (CAD), have diffused into the care of older women. Methods Using the linked Surveillance, Epidemiology, and End Results–Medicare database, we identified 137 274 women ages 66 to 100 years who had not had breast cancer and assessed the cost to fee-for-service Medicare of breast cancer screening and workup during 2006 to 2007. For women who developed cancer, we calculated initial treatment cost. We then assessed screening-related cost at the Hospital Referral Region (HRR) level and evaluated the association between regional expenditures and workup test utilization, cancer incidence, and treatment costs. Results In the United States, the annual costs to fee-for-service Medicare for breast cancer screening-related procedures (comprising screening plus workup) and treatment expenditures were $1.08 billion and $1.36 billion, respectively. For women 75 years or older, annual screening-related expenditures exceeded $410 million. Age-standardized screening-related cost per beneficiary varied more than 2-fold across regions (from $42 to $107 per beneficiary); digital screening mammography and CAD accounted for 65% of the difference in screening-related cost between HRRs in the highest and lowest quartiles of cost. Women residing in HRRs with high screening costs were more likely to be diagnosed as having early-stage cancer (incidence rate ratio, 1.78 [95% CI, 1.40-2.26]). There was no significant difference in the cost of initial cancer treatment per beneficiary between the highest and lowest screening cost HRRs ($151 vs $115; P = .20). Conclusions The cost to Medicare of breast cancer screening exceeds $1 billion annually in the fee-for-service program. Regional variation is substantial and driven by the use of newer and more expensive technologies; it is unclear whether higher screening expenditures are achieving better breast cancer outcomes.
