Brawer M, Parson R, Costa M, Scheil B; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1997; 13: 161.
Lash Group Heathcare Consultants, Washington, DC, USA.
OBJECTIVE: To determine the financial impact on a managed care plan of ten years of serial prostate specific antigen (PSA) testing. METHODS: A longitudinal actuarial model was deigned to assess the per member per month (PMPM) impacts of digital rectal exam (DRE), and of DRE plus PSA testing, performed during an annual physical exam on a representative sample of managed care males aged 50-64. The model incorporates published clinical data, epidemiological data, and managed care payer information. Model logic flow is derived from a clinical pathway that includes: testing, biopsy, and cancer detection rates; probable treatments by stage (watchful waiting, prostatectomy, radiation, hormonal treatment, orchiectomy); and terminal care. Major cost breakdowns are compared in terms of testing, treatment, monitoring, relapse and terminal care. Sensitivity analyses compare testing frequency, plan turnover rates, initial cohort cancer prevalence, and treatment mix assumptions. RESULTS: A shift to earlier stage cancers and a decreasiang number of terminal care patients result in variable incremental PMPM impacts. CONCLUSION: Actuarial modeling provides a useful approach to estimate real world impacts on managed care plans of adopting a PSA early detection policy. PMPM calculations may prove more useful to managed care plans in policy determination than other approaches; eg., cost-effectiveness studies.
Publication Types:
Keywords:
- Biopsy
- Cost-Benefit Analysis
- Health Planning
- Humans
- Male
- Neoplasm Staging
- Orchiectomy
- Physical Examination
- Prostate-Specific Antigen
- Prostatectomy
- Research Design
- Sensitivity and Specificity
- economics
- immunology
- methods
- surgery
- hsrmtgs
Other ID:
UI: 102233381
From Meeting Abstracts