Evolution of XXXX screening in the Medicare population: clinical and economic implications.

@entity1 @entity5 @entity0
BACKGROUND: Newer approaches to mammography, including digital image acquisition and computer-aided detection (CAD), and adjunct imaging (e.g., magnetic resonance imaging [MRI]) have diffused into clinical practice. The impact of these technologies on screening-related cost and outcomes remains undefined, particularly among older @entity1 . METHODS: Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we constructed two cohorts of @entity1 without a history of @entity0 and followed each cohort for 2 years. We compared the use and cost of screening mammography including digital mammography and CAD, adjunct procedures including breast ultrasound, MRI, and biopsy between the period of 2001 and 2002 and the period of 2008 and 2009 using   (2) and t test. We also assessed the change in @entity0 stage and incidence rates using   (2) and Poisson regression. All statistical tests were two-sided. RESULTS: There were 137150 @entity1 (mean age = 76.0 years) in the early cohort (2001-2002) and 133097 @entity1 (mean age = 77.3 years) in the later cohort (2008-2009). The use of digital image acquisition for screening mammography increased from 2.0% in 2001 and 2002 to 29.8% in 2008 and 2009 (P < .001). CAD use increased from 3.2% to 33.1% (P < .001). Average screening-related cost per capita increased from  76 to  112 (P < .001), with annual national fee-for-service Medicare spending increasing from  666 million to  962 million. There was no statistically significant change in detection rates of early-stage @entity5 (2.45 vs 2.57 per 1000 @entity1 -years; P = .41). CONCLUSIONS: Although @entity0 screening-related costs increased substantially from 2001 through 2009 among Medicare beneficiaries, a clinically significant change in stage at diagnosis was not observed.
