The Impact of Medicare Health Insurance Coverage on Lung Cancer Screening

Abstract Background Numerous health policy organizations recommend lung cancer screening, but no consensus exists on the optimal policy. Moreover, the impact of the Lung CT screening reporting and data system guidelines to manage small pulmonary nodules of unknown significance (a.k.a. indeterminate nodules) on the cost-effectiveness of lung cancer screening is not well established. Methods We assess the cost-effectiveness of 199 screening strategies that vary in terms of age and smoking eligibility criteria, using a microsimulation model. We simulate lung cancer-related events throughout the lifetime of US-representative current and former smokers. We conduct sensitivity analyses to test key model inputs and assumptions. Results The cost-effectiveness efficiency frontier consists of both annual and biennial screening strategies. Current guidelines are not on the frontier. Assuming 4% disutility associated with indeterminate findings, biennial screening for smokers aged 50–70 years with at least 40 pack-years and less than 10 years since smoking cessation is the cost-effective strategy using $100 000 willingness-to-pay threshold yielding the highest health benefit. Among all health utilities, the cost-effectiveness of screening is most sensitive to changes in the disutility of indeterminate findings. As the disutility of indeterminate findings decreases, screening eligibility criteria become less stringent and eventually annual screening for smokers aged 50–70 years with at least 30 pack-years and less than 10 years since smoking cessation is the cost-effective strategy yielding the highest health benefit. Conclusions The disutility associated with indeterminate findings impacts the cost-effectiveness of lung cancer screening. Efforts to quantify and better understand the impact of indeterminate findings on the effectiveness and cost-effectiveness of lung cancer screening are warranted.

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The Role of Health Insurance Coverage in Cancer Screening Utilization

Journal of Health Care for the Poor and Underserved ◽

10.1353/hpu.0.0048 ◽

2008 ◽

Vol 19 (3) ◽

pp. 842-856 ◽

Cited By ~ 33

Author(s):

JaMuir M. Robinson ◽

Vickie Shavers

Keyword(s):

Health Insurance ◽

Cancer Screening ◽

Insurance Coverage ◽

Health Insurance Coverage

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The Influences of Health Insurance and Access to Information on Prostate Cancer Screening among Men in Dominican Republic

Journal of Cancer Epidemiology ◽

10.1155/2016/7284303 ◽

2016 ◽

Vol 2016 ◽

pp. 1-11 ◽

Cited By ~ 3

Author(s):

Joseph Kangmennaang ◽

Isaac Luginaah

Keyword(s):

Prostate Cancer ◽

Health Insurance ◽

Cancer Screening ◽

Dominican Republic ◽

Prostate Cancer Screening ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Logit Regression ◽

Binary Logit ◽

Binary Logit Regression

Objectives.Although research demonstrates the public health burden of prostate cancer among men in the Caribbean, relatively little is known about the factors that underlie the low levels of testing for the disease among this population.Study Design.A cross-sectional study of prostate cancer testing behaviours among men aged 40–60 years in Dominican Republic using the Demographic and Health Survey (2013).Methods.We use hierarchical binary logit regression models and average treatment effects combined with propensity score matching to explore the determinants of prostate screening as well as the average effect of health insurance coverage on screening. The use of hierarchical binary logit regression enabled us to control for the effect of unobserved heterogeneity at the cluster level that may affect prostate cancer testing behaviours.Results.Screening varied significantly with health insurance coverage, knowledge of cholesterol level, education, and wealth. Insured men were more likely to test for prostate cancer (OR = 1.65,p=0.01) compared to the uninsured.Conclusions.The expansion and restructuring of Dominican Republic universal health insurance scheme to ensure equity in access may improve health access that would potentially impact positively on prostate cancer screening among men.

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