| Abstract | BACKGROUND: The efficacy of prophylactic mastectomy and oophorectomy in reducing breast and ovarian carcinoma has recently been reported in high-risk women. Because cost has become central to medical decision-making, this study was designed to evaluate currently existing coverage policies for these procedures. METHODS: A confidential detailed cross-sectional nationwide survey of 481 medical directors from the American Association of Health Plans, Medicare, and Medicaid was conducted. RESULTS: Of the 150 respondents, 65% (n = 97) had 100,000 or more enrolled members and 35% (n = 53) had fewer than 100,000 enrolled members. Only 44% of private plans have specific policies for coverage of prophylactic mastectomy for a strong family history of breast cancer and 38% of plans for a BRCA mutation. Only 20% of total responding plans had a policy for coverage of prophylactic oophorectomy under any clinical circumstance. Governmental carriers were significantly less likely to have any policy for prophylactic surgery (range, 2%-12%) compared with nongovernmental plans (range, 24%-44%; P < .001). No significant regional differences for coverage policies were identified (P > .05). CONCLUSIONS: Significant variations currently exist for health insurance coverage of prophylactic mastectomy and oophorectomy. As genetic testing becomes widespread, more uniform policies should be established to enable appropriate high-risk candidates equal access and coverage for these procedures. |
| Authors | H M Kuerer, E S Hwang, J P Anthony, R A Dudley, B Crawford, W M Aubry, L J Esserman
(Affiliation: Department of Surgery, University of California at San Francisco, USA.)
|
| Journal | Annals of surgical oncology
(Ann Surg Oncol)
Vol. 7
Issue 5
Pg. 325-32
(Jun 2000)
ISSN: 1068-9265 UNITED STATES |
| PMID | 10864338
(Publication Type: Journal Article)
|
| Chemical References |
- BRCA2 Protein
- Neoplasm Proteins
- Transcription Factors
|
| Topics |
- BRCA2 Protein
- Breast Neoplasms
(genetics, prevention & control, surgery)
- Cost-Benefit Analysis
- Decision Making
- Female
- Genes, BRCA1
- Genetic Screening
- Health Care Surveys
(statistics & numerical data)
- Health Policy
(economics)
- Humans
- Insurance Coverage
(economics)
- Insurance, Health
(economics)
- Mastectomy
(economics)
- Neoplasm Proteins
(genetics)
- Ovarian Neoplasms
(genetics, prevention & control, surgery)
- Ovariectomy
(economics)
- Patient Selection
- Risk Factors
- Transcription Factors
(genetics)
|
