The CEA Registry Blog

By CEA Registry Team on 1/22/2015 10:09 AM

The Social Security Act established the Medicare program in 1965 to cover services “reasonable and necessary for diagnosis or treatment.” The first coverage for a preventive service (pneumococcal inoculation) under the program did not occur until Congressional action in 1980. Today, Medicare covers 23 preventive services.

Figure 1: Timeline of Preventative Services Covered for Medicare Beneficiaries
 


 
Click to view a larger image.

Read more about Medicare coverage of preventive services and the use of cost-effectiveness analysis in the blog post and the Health Policy paper.

References

1.    Chambers, JD, Cangelosi, MJ, Neumann, PJ. Medicare’s use of cost-effectiveness analysis for prevention (but not for treatment). Health Policy 2014 Nov 22. [Epub ahead of print]

By CEA Registry Team on 1/20/2015 2:22 PM

By James Chambers, PhD

In a new paper published in Health Policy, my colleagues and I investigated the use of cost-effectiveness analysis (CEA) in Medicare coverage of prevention. We found that cost-effectiveness has played a longstanding role in coverage determinations for several preventive health services.  In contrast, no such consideration is used in coverage of treatments. While Medicare once dealt primarily with paying claims for treatments, preventative services have been gradually added to the program, with their addition becoming more commonplace over the past ten years. There has been little examination to date of the role CEA has played in coverage determinations for preventive measures.

When preventive services were initially added to the program, it was through Congressional action that required evidence of affordability. Of the 23 preventive services currently covered by Medicare, CEA played a role in coverage for nine. For example, CEA was used in coverage determinations for pneumococcal vaccine (1981), HIV screening (2010), and screening and behavioral counseling for alcohol misuse (2011). In addition, CEA was considered in multiple cases when Medicare decided not to cover a preventive service, e.g., screening computed tomography colonography (CTC) for colorectal cancer.

In other ways, the US has increasingly made efforts to promote preventive care – such as the addition of the annual wellness visit to the Medicare benefits package (2011).  However, by evaluating the cost-effectiveness of preventive services and not treatment, the government holds prevention to a stricter evidence standard.  Using CEA for prevention and not for treatment is a double standard. Expanding the role of CEA in Medicare coverage to include treatment would add balance and evidence to the process, and efficiency to the program.


References

1.    Chambers, JD, Cangelosi, MJ, Neumann, PJ. Medicare’s use of cost-effectiveness analysis for prevention (but not for treatment). Health Policy 2014 Nov 22. [Epub ahead of print]

By CEA Registry Team on 7/27/2011 2:31 PM

July 28th is World Hepatitis Day.  In recognition, we searched the CEA Registry for estimates of cost-effectiveness of hepatitis C (HCV) screening (Table 1). 

Globally, hepatitis is a hugely burdensome disease with nearly 1 in 12 people suffering from hepatitis. [1]  If left undiagnosed and untreated, hepatitis can lead to disability, liver scarring, and liver cancer. 

The results of our search show a wide range of cost-effectiveness estimates for hepatitis screening, from dominant strategies (more effective and less costly than the comparator) to those that are dominated (less effective and more costly than the comparator).  Strategies that target people with risk factors for contracting hepatitis are the most cost-effective, including strategies targeting injection drug users and the prison population. 
 

Table 1. Cost-effectiveness of hepatitis C screening in a variety of circumstances

Reference
US$/QALY
Intervention      
Comparator      Target Population               
Tramarin 2008 Curr Pharm Des (PMID 18673188) Cost-Saving HCV serology every 6 month, lifelong No screening Injected Drug Users (IDUs) in the Veneto Region, Italy
 
Pereira 2000 Transfusion (11061853) Cost-Saving Screening blood for HCV using current protocols Screening blood for HCV using surrogate markers Blood transfusion recipients
Stein 2004 J Public Health (Oxf) (15044577) 50000 Screening for HCV No Screening Patients with history of drug use
Sutton 2008 J Viral Hepat (18637074) 120000 Screening for HCV Usual care -- symptomatic testing within community Prison population of England and Wales
Stein 2003 J Hepatol (14568266) 150000 Universal screening for HCV No screening    Adult patients attending genitourinary medicine clinics in England
Leal 1999 J Med Screen (10572842) 150000 Screening for HCV    Status quo IV drug users in contact with the health care system in South and West health regions of the UK.
Plunkett 2005 Am J Obstet Gynecol (15846195) 1.40E+06 HCV screening, treatment, and elective cesarean delivery No screening Asymptomatic, HIV-negative pregnant women without risk factors for HCV infection who received routine prenatal care in the US
Pereira 2000 Transfusion (11061853) 2.40E+06 Screening HCV using RNA testing added to current protocols Screening blood for HCV using current protocols Blood transfusion recipients
Plunkett 2005 Am J Obstet Gynecol (15846195) Dominated HCV screening and treatment    No screening Asymptomatic, HIV-negative pregnant women without risk factors who received routine prenatal care in the US
Singer 2001 Am J Med (11755504) Dominated Screening for HCV No screening Asymptomatic, average risk adults (HCV)

 

These findings are consistent with those in Cohen et al 2009. [2]  In certain circumstances screening offers tremendous value, increasing health while decreasing the overall cost of care.  However, in other circumstances screening strategies can be highly cost-ineffective, resulting in little or no health gain for the investment.  While screening offers great potential to increase health and generate cost-savings, it is important to target appropriate populations (e.g., those at risk).

You can find out more information regarding hepatitis, including information on prevention, diagnosis, and treatment at: http://www.worldhepatitisalliance.org.

By: Michael J. Cangelosi and James D. Chambers

References
[1] ELPA-info.org (2010) Avilable Online at:www.elpa-info.org
[2] Cohen JT, Neumann PJ, Weinstein MC. Does preventive care save money? Health economics and the presidential candidates. N Engl J Med. 2008 Feb 14;358(7):661-3

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