• Hypertrophic Cardiomyopathy (HCM)
  • Vaccines: 2023 Year in Review
  • Eyecare
  • Urothelial Carcinoma
  • Women's Health
  • Hemophilia
  • Heart Failure
  • Vaccines
  • Neonatal Care
  • NSCLC
  • Type II Inflammation
  • Substance Use Disorder
  • Gene Therapy
  • Lung Cancer
  • Spinal Muscular Atrophy
  • HIV
  • Post-Acute Care
  • Liver Disease
  • Biologics
  • Asthma
  • Atrial Fibrillation
  • RSV
  • COVID-19
  • Cardiovascular Diseases
  • Prescription Digital Therapeutics
  • Reproductive Health
  • The Improving Patient Access Podcast
  • Blood Cancer
  • Ulcerative Colitis
  • Respiratory Conditions
  • Multiple Sclerosis
  • Digital Health
  • Population Health
  • Sleep Disorders
  • Biosimilars
  • Plaque Psoriasis
  • Leukemia and Lymphoma
  • Oncology
  • Pediatrics
  • Urology
  • Obstetrics-Gynecology & Women's Health
  • Opioids
  • Solid Tumors
  • Autoimmune Diseases
  • Dermatology
  • Diabetes
  • Mental Health

Mammography cost includes follow-up

Article

Mammograms contribute 62% of the cost and the remaining 38% is attributed to follow-on diagnostics.

study of 1 million women who were screened for breast cancer with mammography showed the average cost per-episode, per-patient age 30 to 64 is $249.70. The cost reflects the 17% of episodes that

included follow-on testing.

While breast cancer screening rates have remained steady for more than a decade, according to HEDIS measures, the provision in the Affordable Care Act (ACA) to require mammography screening benefits with no member out-of-pocket costs has the potential to increase utilization. More than 70% of HMO members and 66% of PPO members adhered to the recommendations of biennial screenings in 2013.

According to the study, the mammogram itself contributes 62% of the cost, and the remaining 38% is attributed to follow-on diagnostics.  

  • Nearly 18% of the total episode cost is attributed to biopsies;

  • 8.3% from sonograms;

  • 7.2% from follow-up diagnostic mammograms; 

  • 4.2% from MRIs; and

  • Less than 1% is attributed to molecular breast imaging and other radiological imaging procedures, such as CT scans.

Milliman, which conducted the analysis from private-payer claims data, found variation in diagnostic utilization. With an overall 2.4% rate of biopsy, there was also a 19% breast
cancer surgery rate after biopsy, which researchers say suggests an 81% false positive rate resulting from breast biopsy procedures.

Among the recommendations, Milliman advises plans should review their claims experience for follow-on diagnostics and biopsies.
Additionally, guidelines for breast cancer screening can change with new evidence, so plans should review coverage policies periodically to be consistent with best practices.

The report was commissioned by Gamma Medica, which manufactures a molecular breast imaging diagnostic tool.

Related Videos
Related Content
© 2024 MJH Life Sciences

All rights reserved.