Current national health insurance coverage policies for breast and ovarian cancer prophylactic surgery.

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
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 7 Issue 5 Pg. 325-32 (Jun 2000) ISSN: 1068-9265 [Print] 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 Testing
• 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)