Eleven years ago this month, the scans and exams that hold the most power to spot the early signs of cancer became available for free to many American adults through the passing of the Affordable Care Act. Now, two new studies show that when those screening tests reveal potentially troubling signs, patients could face hundreds of dollars in costs for follow-up tests.
Their findings could inform efforts to ensure that patients follow up on abnormal test results and don’t delay care due to cost.
The studies looked particularly at out-of-pocket costs billed to those who had computed tomography (CT) scans to screen for lung cancer and to women after an abnormal Papanicolaou, or Pap, smear or cervical exam.
Costs After an Abnormal Lung CT Scan
The first paper, published by Tailor et al in the Journal of the American College of Radiology, looked at what patients were billed for the lung biopsies and other invasive procedures used to follow up on an abnormal lung CT scan. In all, 7.4% of the patients who had a lung cancer screening CT went on to have at least one follow-up invasive procedure. While 20% of patients in this group were diagnosed with lung cancer, the rate of procedures “downstream” of the screening CT was higher than what was seen in the clinical trials of this type of screening. Such studies established the value of lung CT screening in certain older adults and led to no-cost access in 2013.
Over half of the patients who had a procedure after their lung scan were asked to pay something. The total cost of managing this population of was $5,060,511.04, with an average per-episode total cost of $740.06. The aggregate out-of-pocket costs to this population of lung screeners was $427,069.74, with an average per-episode out-of-pocket cost of $62.46.
Now that more American adults are eligible for free lung cancer screening, due to new evidence about its ability to spot disease early, the authors wrote that insurers may want to consider ways to reduce the cost burden on those with abnormal scans who need follow-up care to determine if cancer is present.
Costs After Colposcopy
The second paper, published by Fendrick et al in the journal Obstetrics & Gynecology, examined what women paid out of their own pockets for colposcopy. Conducted after a Pap smear, human papillomavirus test, or routine cervical exam shows abnormal results, a colposcopy can include a biopsy or other procedures.
Women who had a colposcopy without further procedures paid an average of $112, while those who had cells taken for further examination paid $155 on average. Those who had further procedures faced hundreds of dollars more in costs—and this out-of-pocket cost rose sharply during the 13 years studied. By 2019, a woman who had additional care beyond a biopsy could expect to face a total bill of nearly $1,000.
“Costs much lower than these have been shown to prevent women from obtaining recommended health care,” said study coauthor Michelle H. Moniz, MD, MSc. “It is high time we consider eliminating financial barriers to recommended care to prevent cancer.”
“The Affordable Care Act requires enhanced preventive care coverage for over 150 million Americans, including initial screening tests for breast, cervical, colorectal, and lung cancers,” said first study author A. Mark Fendrick, MD. “Since screening for these cancers often requires multiple steps, health insurers should remove barriers that may create financial hardship or deter an individual from completing the screening process.”
Disclosure: For full disclosures of the study authors, visit jacr.org and journals.lww.com/greenjournal.
