Reallocating Cervical Cancer Preventive Service Spending from Low- to High-Value Clinical Scenarios

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dc.contributor.authorRockwell, Michelle S.en
dc.contributor.authorArmbruster, Shannon D.en
dc.contributor.authorCapucao, Jillian C.en
dc.contributor.authorRussell, Kyle B.en
dc.contributor.authorRockwell, John A.en
dc.contributor.authorPerkins, Karen E.en
dc.contributor.authorHuffstetler, Alison N.en
dc.contributor.authorMafi, John N.en
dc.contributor.authorFendrick, A. Marken
dc.date.accessioned2023-08-25T16:51:02Zen
dc.date.available2023-08-25T16:51:02Zen
dc.date.issued2023-07-05en
dc.date.updated2023-08-25T15:16:33Zen
dc.description.abstractTimely follow-up care after an abnormal cervical cancer screening test result is critical to the prevention and early diagnosis of cervical cancer. The current inadequate and inequitable delivery of these potentially life-saving services is attributed to several factors, including patient out-of-pocket costs. Waiving of consumer cost-sharing for follow-up testing (e.g., colposcopy and related cervical services) is likely to improve access and uptake, especially among underserved populations. One approach to defray the incremental costs of providing more generous coverage for follow-up testing is reducing expenditures on "low-value" cervical cancer screening services. To explore the potential fiscal implications of a policy that redirects cervical cancer screening resources from potentially low- to high-value clinical scenarios, we analyzed 2019 claims from the Virginia All-Payer Claims Database to quantify (i) total spending on low-value cervical cancer screening and (ii) out-of-pocket costs associated with colposcopy and related cervical services among commercially insured Virginians. In a cohort of 1,806,921 female patients (ages 48.1 ± 24.8 years), 295,193 claims for cervical cancer screening were reported, 100,567 (34.0%) of which were determined to be low-value ($4,394,361 total; $4,172,777 for payers and $221,584 out-of-pocket [$2/patient]). Claims for 52,369 colposcopy and related cervical services were reported ($40,994,016 total; $33,457,518 for payers and $7,536,498 out-of-pocket [$144/patient]). These findings suggest that reallocating savings incurred from unnecessary spending to fund more generous coverage of necessary follow-up care is a feasible approach to enhancing cervical cancer prevention equity and outcomes. PREVENTION RELEVANCE: Out-of-pocket fees are a barrier to follow-up care after an abnormal cervical cancer screening test. Among commercially insured Virginians, out-of-pocket costs for follow-up services averaged $144/patient; 34% of cervical cancer screenings were classified as low value. Reallocating low-value cervical cancer screening expenditures to enhance coverage for follow-up care can improve screening outcomes. See related Spotlight, p. 363.en
dc.description.versionPublished versionen
dc.format.extentPages 385-391en
dc.format.mimetypeapplication/pdfen
dc.identifier.doihttps://doi.org/10.1158/1940-6207.CAPR-22-0531en
dc.identifier.eissn1940-6215en
dc.identifier.issn1940-6207en
dc.identifier.issue7en
dc.identifier.orcidArmbruster, Shannon [0000-0003-4884-6737]en
dc.identifier.orcidRockwell, Michelle [0000-0001-7910-6083]en
dc.identifier.other719063 (PII)en
dc.identifier.pmid36976753en
dc.identifier.urihttp://hdl.handle.net/10919/116131en
dc.identifier.volume16en
dc.language.isoenen
dc.publisherAmerican Association for Cancer Researchen
dc.relation.urihttps://www.ncbi.nlm.nih.gov/pubmed/36976753en
dc.rightsCreative Commons Attribution-NonCommercial-NoDerivatives 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.subject3215 Reproductive Medicineen
dc.subject32 Biomedical and Clinical Sciencesen
dc.subjectHealth Servicesen
dc.subjectCervical Canceren
dc.subjectPreventionen
dc.subjectCanceren
dc.subjectClinical Researchen
dc.subject3 Good Health and Well Beingen
dc.subject3202 Clinical sciencesen
dc.subject3211 Oncology and carcinogenesisen
dc.subject.meshHumansen
dc.subject.meshHealth Expendituresen
dc.subject.meshUterine Cervical Neoplasmsen
dc.subject.meshFemaleen
dc.subject.meshEarly Detection of Canceren
dc.titleReallocating Cervical Cancer Preventive Service Spending from Low- to High-Value Clinical Scenariosen
dc.title.serialCancer Prevention Researchen
dc.typeArticle - Refereeden
dc.type.dcmitypeTexten
dc.type.otherJournal Articleen
dcterms.dateAccepted2023-03-24en
pubs.organisational-group/Virginia Techen
pubs.organisational-group/Virginia Tech/Agriculture & Life Sciencesen
pubs.organisational-group/Virginia Tech/Agriculture & Life Sciences/Human Nutrition, Foods, & Exerciseen
pubs.organisational-group/Virginia Tech/Faculty of Health Sciencesen
pubs.organisational-group/Virginia Tech/VT Carilion School of Medicineen
pubs.organisational-group/Virginia Tech/VT Carilion School of Medicine/OB GYNen
pubs.organisational-group/Virginia Tech/VT Carilion School of Medicine/OB GYN/Gynecologic Oncologyen

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