National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 24 of 24 Research Studies DisplayedOke I, Lutz SM, Hunter DG
Use and costs of instrument-based vision screening for US children aged 12 to 36 months.
This research letter describes a cohort study that examined patterns and out-of-pocket costs of instrument-based vision screening among US children 12 to 36 months. The authors used 2018 MarketScan Commerical Claims and Encounters data as of January 1, 2018 and excluded those with fewer than 12 months of continuous insurance coverage, enrollment in capitated insurance plans, no preventive care encounters, or missing data on residents. The study included 246,077 children. Instrument-based vision screening was received by 19.5% (n = 48,101) of children during 2018. Median (IQR) practitioner payment for instrument-based vision screening claims was $13. Screening incurred out-of-pocket expenses for 7% of children; 30% of these children had expenses related to co-payment, 20.2% to coinsurance, and 50.7% to deductibles. Median (IQR) out-of-pocket expense was $11. Increased odds of vision screening were associated with older age, high-deductible plan enrollment, having more than 1 preventative visit, and receiving care within an area in the highest quartile of practitioner payment. This study was limited by use of commercial claims data, which excluded 45% of children with public or no coverage. Nationwide prevalence of vision screening therefore may differ for the general population.
AHRQ-funded; HS000063.
Citation: Oke I, Lutz SM, Hunter DG .
Use and costs of instrument-based vision screening for US children aged 12 to 36 months.
JAMA Pediatr 2023 Jul; 177(7):728-30. doi: 10.1001/jamapediatrics.2023.0808..
Keywords: Newborns/Infants, Eye Disease and Health, Screening, Prevention, Healthcare Costs
Cusick MM, Tisdale RL, Chertow GM
Population-wide screening for chronic kidney disease : a cost-effectiveness analysis.
The purpose of this study was to assess the cost-effectiveness of adding population-wide screening for chronic kidney disease (CKD), specifically; screening for albuminuria with and without adding Sodium-glucose cotransporter-2 (SGLT2) inhibitors to the current standard of care for CKD. The study found that one-time CKD screening at the age 55 years had an ICER of $86,300 per QALY gained by increasing costs from $249,800 to $259,000 and increasing QALYs from 12.61 to 12.72; this result was accompanied by a decrease in the incidence of kidney failure requiring dialysis or kidney transplant of 0.29 percentage points and an increase in life expectancy from 17.29 to 17.45 years. In the group aged 35 to 75 years, screening one time prevented dialysis or transplant in 398, 000 people and screening every 10 years until age the age of 75 years cost less than $100,000 per QALY gained. The study’s sensitivity analysis found that when SGLT2 inhibitors were 30% less effective, screening every 10 years during ages 35 to 75 years cost between $145,400 and $182,600 per QALY gained, and decreases in the price would be necessary for screening to be cost-effective.
AHRQ-funded; HS026128.
Citation: Cusick MM, Tisdale RL, Chertow GM .
Population-wide screening for chronic kidney disease : a cost-effectiveness analysis.
Ann Intern Med 2023 Jun; 176(6):788-97. doi: 10.7326/m22-3228..
Keywords: Kidney Disease and Health, Screening, Healthcare Costs, Chronic Conditions
Fendrick AM, Dalton VK, Tilea A
Out-of-pocket costs for colposcopy among commercially insured women from 2006 to 2019.
The objective of this study was to describe out-of-pocket costs for colposcopy and related services among age-appropriate, commercially insured women from 2006 to 2019. Findings suggested that out-of-pocket costs for colposcopy were very common and significant and have increased over time. Reported out-of-pocket costs for cervical cancer screening-related care, such as office visits, were not included, thus the findings may underestimate patients’ total financial burden.
AHRQ-funded; HS025465.
Citation: Fendrick AM, Dalton VK, Tilea A .
Out-of-pocket costs for colposcopy among commercially insured women from 2006 to 2019.
Obstet Gynecol 2022 Jan;139(1):113-15. doi: 10.1097/aog.0000000000004582..
Keywords: Healthcare Costs, Colonoscopy, Screening, Cancer: Cervical Cancer, Cancer, Prevention, Women
Chen HF, Rose AM, Waisbren S
Newborn screening and treatment of phenylketonuria: projected health outcomes and cost-effectiveness.
This study’s objective was to evaluate the cost-effectiveness of newborn screening and treatment for phenylketonuria (PKU) in the context of new data on adherence to a recommended diet treatment and a newly available drug (sapropterin dihydrochloride). A computer simulation model was developed to project outcomes for a hypothetical cohort of newborns which compared four strategies. The strategies compared were: 1) clinical identification (CI) with diet treatment; 2) newborn screening (NBS) with diet treatment; 3) CI with diet and medication; and 4) NBS with diet and medication. The range of incremental cost-effectiveness ratio went from $6400/QALY for newborn screening with diet treatment compared to clinical identification with diet treatment up to $16,000,000/QALY for adding medication to NBS with diet treatment. Future research is needed to consider conditions under which sapropterin dihydrochloride would be more economically attractive.
AHRQ-funded; HS020644.
Citation: Chen HF, Rose AM, Waisbren S .
Newborn screening and treatment of phenylketonuria: projected health outcomes and cost-effectiveness.
Children 2021 May 12;8(5). doi: 10.3390/children8050381..
Keywords: Newborns/Infants, Neurological Disorders, Screening, Healthcare Costs
Shah SC, Canakis A, Peek RM
Endoscopy for gastric cancer screening is cost effective for Asian Americans in the United States.
Endoscopic screening for gastric cancer is routine in some countries with high incidence and is associated with reduced gastric cancer-related mortality. Immigrants from countries of high incidence to low incidence of gastric cancer retain their elevated risk, but no screening recommendations have been made for these groups in the United States. In this study the investigators aimed to determine the cost effectiveness of different endoscopic screening strategies for noncardia gastric cancer, compared with no screening, among Chinese, Filipino, Southeast Asian, Vietnamese, Korean, and Japanese Americans.
AHRQ-funded; HS026395.
Citation: Shah SC, Canakis A, Peek RM .
Endoscopy for gastric cancer screening is cost effective for Asian Americans in the United States.
Clin Gastroenterol Hepatol 2020 Dec;18(13):3026-39. doi: 10.1016/j.cgh.2020.07.031..
Keywords: Cancer, Digestive Disease and Health, Screening, Racial and Ethnic Minorities, Healthcare Costs
Skaathun B, Pho MT, Pollack HA
Comparison of effectiveness and cost for different HIV screening strategies implemented at large urban medical centre in the United States.
This analysis compared the effectiveness and cost of three HIV testing strategies in a high HIV burden area in the U.S. in identifying new HIV infections. The investigators performed a cost analysis comparing three HIV testing strategies in Chicago: (1) routine screening (RS) in an inpatient and outpatient setting, (2) modified partner services (MPS) among networks of the recently HIV infected and diagnosed, and (3) a respondent drive sampling (RDS)-based social network (SN) approach targeting young African-American men who have sex with men.
AHRQ-funded; HS000084.
Citation: Skaathun B, Pho MT, Pollack HA .
Comparison of effectiveness and cost for different HIV screening strategies implemented at large urban medical centre in the United States.
J Int AIDS Soc 2020 Oct;23(10):e25554. doi: 10.1002/jia2.25554..
Keywords: Human Immunodeficiency Virus (HIV), Screening, Healthcare Costs, Prevention, Infectious Diseases
Greenhawt M, Shaker M
Determining levers of cost-effectiveness for screening infants at high risk for peanut sensitization before early peanut introduction.
The authors sought to identify scenarios in which current early peanut introduction guidelines would be cost-effective. They found that the current screening approach to early peanut introduction could be cost-effective at a particular health utility for an in-clinic reaction, skin prick test sensitivity and specificity, and high baseline peanut allergy prevalence among high-risk infants. However, such conditions are unlikely to be plausible to achieve realistically. They recommend further research to define the health state utility associated with reaction location.
AHRQ-funded; HS024599.
Citation: Greenhawt M, Shaker M .
Determining levers of cost-effectiveness for screening infants at high risk for peanut sensitization before early peanut introduction.
JAMA Netw Open 2019 Dec 2;2(12):e1918041. doi: 10.1001/jamanetworkopen.2019.18041..
Keywords: Patient-Centered Outcomes Research, Newborns/Infants, Children/Adolescents, Respiratory Conditions, Skin Conditions, Screening, Healthcare Costs, Evidence-Based Practice, Guidelines
Hassmiller Lich K, O'Leary MC, Nambiar S
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Researchers used microsimulation to estimate the health and financial effects of insurance expansion and reduction scenarios in North Carolina (NC) for colorectal cancer screening (CRC). The full lifetime of a simulated population of residents age-eligible for CRC screening (aged 50-75) during a 5-year period were simulated. Findings indicate that the estimated cost savings--balancing increased CRC screening/testing costs against decreased cancer treatment costs--were approximately $30 M and $970 M for Medicaid expansion and Medicare-for-all scenarios, respectively, compared to status quo. The researchers concluded that insurance expansion will likely improve CRC screening both overall and in underserved populations while saving money, with the largest savings realized by Medicare.
AHRQ-funded; HS022981.
Citation: Hassmiller Lich K, O'Leary MC, Nambiar S .
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Prev Med 2019 Dec;129s:105847. doi: 10.1016/j.ypmed.2019.105847..
Keywords: Health Insurance, Cancer: Colorectal Cancer, Cancer, Healthcare Costs, Screening, Prevention, Medicaid, Medicare, Policy, Access to Care
Song LD, Newhouse JP, Garcia-De-Albeniz X
Changes in screening colonoscopy following Medicare reimbursement and cost-sharing changes.
This study examined changes in screening colonoscopy rates after Medicare reimbursement and cost-sharing changed when the Affordable Care Act (ACA) was implemented. A 20% random sample of fee-for-service (FFS) Medicare claims from 2002-2012 was used in this study. Screening colonoscopy rates did increase after 2001 when cost-sharing was eliminated but the amount varied depending on the algorithm used to classify the indication.
AHRQ-funded; HS023128.
Citation: Song LD, Newhouse JP, Garcia-De-Albeniz X .
Changes in screening colonoscopy following Medicare reimbursement and cost-sharing changes.
Health Serv Res 2019 Aug;54(4):839-50. doi: 10.1111/1475-6773.13150..
Keywords: Colonoscopy, Healthcare Costs, Healthcare Utilization, Medicare, Payment, Prevention, Screening
Aouad M, Brown TT, Whaley CM
Reference pricing: the case of screening colonoscopies.
In this study, the investigators studied the introduction of reference pricing to the California Public Employees' Retirement System. The investigators found a 10 percentage point increase in the share of patients using an ambulatory surgery center (ASC), leading to a $2300 to $1700 reduction in prices paid for patients who switched to ASCs. They indicated that their results suggested the use of ASCs had a causal effect on prices paid and had no negative effect on patient health outcomes.
AHRQ-funded; HS022098.
Citation: Aouad M, Brown TT, Whaley CM .
Reference pricing: the case of screening colonoscopies.
J Health Econ 2019 May;65:246-59. doi: 10.1016/j.jhealeco.2019.03.002..
Keywords: Colonoscopy, Shared Decision Making, Health Services Research (HSR), Healthcare Costs, Healthcare Delivery, Screening
Tina Shih YC, Dong W, Xu Y
Assessing the cost-effectiveness of updated breast cancer screening guidelines for average-risk women.
The goal of this study was to evaluate the cost-effectiveness of recently updated US-based mammography screening guidelines. Researchers developed a microsimulation model to generate the natural history of invasive breast cancer and capture how screening and treatment modified the natural course of the disease, and used the model to assess the cost-effectiveness of screening strategies. Results indicated that the hybrid screening strategy that starts annual mammography at the age of 45 years and switches to biennial screening between the ages of 55 and 75 years was the most cost-effective.
AHRQ-funded; HS020263.
Citation: Tina Shih YC, Dong W, Xu Y .
Assessing the cost-effectiveness of updated breast cancer screening guidelines for average-risk women.
Value Health 2019 Feb;22(2):185-93. doi: 10.1016/j.jval.2018.07.880..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Evidence-Based Practice, Prevention, Healthcare Costs
Shaker M, Verma K, Greenhawt M
The health and economic outcomes of early egg introduction strategies.
This study compared the costs and benefits of early egg introduction (EEI) using simulation and Markov modeling over a 20-year horizon with data from the United States, Europe, and Canada. Per child it was more expensive to provide early screening for all children with early-onset eczema than to have a “wait and see” approach. While there would be more egg allergy diagnosis with early screening, the increased costs were too great compared to the no-screening approach.
Citation: Shaker M, Verma K, Greenhawt M .
The health and economic outcomes of early egg introduction strategies.
Allergy 2018 Nov;73(11):2214-23. doi: 10.1111/all.13565..
Keywords: Children/Adolescents, Screening, Healthcare Costs, Diagnostic Safety and Quality, Medication
Cartmell KB, Dismuke CE, Dooley M
Effect of an evidence-based inpatient tobacco dependence treatment service on 1-year postdischarge health care costs.
In 2014, the Medical University of South Carolina (MUSC) implemented a Tobacco Dependence Treatment Service (TDTS) consistent with the Joint Commission (JC) standards recommending that hospitals screen patients for smoking, provide cessation support, and follow-up contact for relapse prevention within 1 month of discharge. This paper examined whether exposure to the TDTS influenced downstream health care charges 12 months after patients were discharged from the hospital.
AHRQ-funded; HS023863.
Citation: Cartmell KB, Dismuke CE, Dooley M .
Effect of an evidence-based inpatient tobacco dependence treatment service on 1-year postdischarge health care costs.
Med Care 2018 Oct;56(10):883-89. doi: 10.1097/mlr.0000000000000979..
Keywords: Healthcare Costs, Inpatient Care, Screening, Substance Abuse, Tobacco Use: Smoking Cessation
Shaker M, Stukus D, Chan ES
"To screen or not to screen": comparing the health and economic benefits of early peanut introduction strategies in five countries.
This study compared the costs and benefits of early peanut introduction (EPI) using data from five countries: US, Canada, Australia, New Zealand and United Kingdom. Per child it was more expensive to provide early screening for all children with early-onset eczema and/or egg allergy than to have a “wait and see” approach. While there would be more peanut allergy diagnosis with early screening, the increased costs were too great compared to the no-screening approach.
AHRQ-funded; HS024599.
Citation: Shaker M, Stukus D, Chan ES .
"To screen or not to screen": comparing the health and economic benefits of early peanut introduction strategies in five countries.
Allergy 2018 Aug;73(8):1707-14. doi: 10.1111/all.13446..
Keywords: Children/Adolescents, Screening, Diagnostic Safety and Quality, Healthcare Costs, Medication, Medication
Eaton EF, Joe W, Kilgore ML
Reverse syphilis screening algorithm fails to demonstrate cost effectiveness in persons living with HIV.
This paper compares the reverse syphilis screening algorithm to the traditional algorithm and the costs for health systems serving persons living with HIV needing annual syphilis screening.
AHRQ-funded; HS023009.
Citation: Eaton EF, Joe W, Kilgore ML .
Reverse syphilis screening algorithm fails to demonstrate cost effectiveness in persons living with HIV.
Int J STD AIDS 2018 May;29(6):563-67. doi: 10.1177/0956462417743409.
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Keywords: Healthcare Costs, Healthcare Costs, Human Immunodeficiency Virus (HIV), Infectious Diseases, Screening
Naber SK, Kuntz KM, Henrikson NB
AHRQ Author: Ganiats TG
Cost effectiveness of age-specific screening intervals for people with family histories of colorectal cancer.
Despite relative risk of colorectal cancer (CRC) decreasing with age among individuals with a family history of CRC, no screening recommendations specify less frequent screening. Researchers found that for individuals with a family history of CRC, it is cost effective to gradually increase the screening interval if several subsequent screening colonoscopies have negative results and no new cases of CRC are found in family members.
AHRQ-authored.
Citation: Naber SK, Kuntz KM, Henrikson NB .
Cost effectiveness of age-specific screening intervals for people with family histories of colorectal cancer.
Gastroenterology 2018 Jan;154(1):105-16.e20. doi: 10.1053/j.gastro.2017.09.021.
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Keywords: Cancer: Colorectal Cancer, Healthcare Costs, Family Health and History, Risk, Screening
Balentine CJ, Vanness DJ, Schneider DF
Cost-effectiveness of lobectomy versus genetic testing (Afirma(R)) for indeterminate thyroid nodules: considering the costs of surveillance.
This study evaluated whether diagnostic thyroidectomy for indeterminate thyroid nodules would be more cost-effective than genetic testing after including the costs of long-term surveillance. Its base case estimate suggests that diagnostic lobectomy dominates genetic testing as a strategy for ruling out malignancy of indeterminate thyroid nodules.
AHRQ-funded; HS023009.
Citation: Balentine CJ, Vanness DJ, Schneider DF .
Cost-effectiveness of lobectomy versus genetic testing (Afirma(R)) for indeterminate thyroid nodules: considering the costs of surveillance.
Surgery 2018 Jan;163(1):88-96. doi: 10.1016/j.surg.2017.10.004.
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Keywords: Cancer, Shared Decision Making, Diagnostic Safety and Quality, Genetics, Healthcare Costs, Screening, Surgery
Kirby JB, Davidoff AJ, Basu J
AHRQ Author: Kirby JB, Basu J
The ACA's zero cost-sharing mandate and trends in out-of-pocket expenditures on well-child and screening mammography visits.
This study used a nationally representative sample of ambulatory care visits to estimate the impact of the zero cost-sharing mandate on out-of-pocket expenditures on well-child and screening mammography visits. It concluded that the Affordable Care Act's zero cost-sharing mandate for preventive care has had a large impact on out-of-pocket expenditures for well-child and mammography visits.
AHRQ-authored.
Citation: Kirby JB, Davidoff AJ, Basu J .
The ACA's zero cost-sharing mandate and trends in out-of-pocket expenditures on well-child and screening mammography visits.
Med Care 2016 Dec;54(12):1056-62. doi: 10.1097/mlr.0000000000000610.
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Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Screening, Women, Policy, Prevention
Roth JA, Gulati R, Gore JL
Economic analysis of prostate-specific antigen screening and selective treatment strategies.
The researchers evaluated the potential cost-effectiveness of plausible prostate-specific antigen (PSA) screening strategies and assessed the value added by increased use of conservative management among low-risk, screen-detected cases. They found that, with contemporary treatment, only strategies with biopsy referral for PSA levels higher than 10.0 ng/mL or age-dependent thresholds were associated with increased quality-adjusted life-years (QALYs), and only quadrennial screening of patients aged 55 to 69 years was potentially cost-effective in terms of cost per QALY. They concluded that, for PSA screening to be cost-effective, it needs to be used conservatively and ideally in combination with a conservative management approach for low-risk disease.
AHRQ-funded; HS022982.
Citation: Roth JA, Gulati R, Gore JL .
Economic analysis of prostate-specific antigen screening and selective treatment strategies.
JAMA Oncol 2016 Jul;2(7):890-8. doi: 10.1001/jamaoncol.2015.6275.
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Keywords: Healthcare Costs, Prevention, Cancer: Prostate Cancer, Quality of Life, Screening
Roth JA, Ramsey SD
Computed tomography screening for lung cancer: A high-value proposition?
This study assessed the cost-effectiveness of low-dose computed tomographic scan screening for lung cancer within the Canadian health care system. It found that compared with no screening, the reference scenario saved 51,000 quality-adjusted life-years (QALY) and had an incremental cost-effectiveness ratio of CaD $52,000/QALY.
HS022982.
Citation: Roth JA, Ramsey SD .
Computed tomography screening for lung cancer: A high-value proposition?
JAMA 2016 Jan 5;315(1):77-8. doi: 10.1001/jama.2015.17877..
Keywords: Cancer: Lung Cancer, Imaging, Screening, Healthcare Costs, Quality of Life
Levy DE, Munshi VN, Ashburner JM
Health IT-assisted population-based preventive cancer screening: a cost analysis.
The researchers analyzed costs from a randomized trial of 2 health IT strategies to improve cancer screening compared with usual care from the perspective of a primary care network. They found that over the course of the study year, the value of reduced physician time devoted to preventive cancer screening outweighed the costs of the interventions.
AHRQ-funded; HS020308; HS018161.
Citation: Levy DE, Munshi VN, Ashburner JM .
Health IT-assisted population-based preventive cancer screening: a cost analysis.
Am J Manag Care 2015 Dec;21(12):885-91..
Keywords: Health Information Technology (HIT), Cancer, Screening, Prevention, Healthcare Costs
Roth JA, Sullivan SD, Goulart BH
Projected clinical, resource use, and fiscal impacts of implementing low-dose computed tomography lung cancer screening in Medicare.
The Centers for Medicare and Medicaid Services (CMS) recently issued a national coverage determination that provides reimbursement for low-dose computed tomography (CT) lung cancer screening for enrollees age 55 to 77 years. This study’s simulation model projected that over 5 years, that low-dose CT screening will result in 10.7 million more low-dose CT scans, 52,000 more lung cancers detected, and increased overall expenditure of $6.8 billion.
AHRQ-funded; HS022982.
Citation: Roth JA, Sullivan SD, Goulart BH .
Projected clinical, resource use, and fiscal impacts of implementing low-dose computed tomography lung cancer screening in Medicare.
J Oncol Pract 2015 Jul;11(4):267-72. doi: 10.1200/jop.2014.002600.
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Keywords: Cancer: Lung Cancer, Screening, Medicare, Healthcare Costs, Healthcare Utilization
Gallego CJ, Shirts BH, Bennette CS
Next-generation sequencing panels for the diagnosis of colorectal cancer and polyposis syndromes: a cost-effectiveness analysis.
The researchers evaluated the cost effectiveness of next-generation sequencing (NGS) panels for the diagnosis of colorectal cancer and polyposis (CRCP) syndromes in patients referred to cancer genetics clinics. They concluded that the use of an NGS panel that includes genes associated with highly penetrant CRCP syndromes in addition to Lynch syndrome genes as a first-line test is likely to provide meaningful clinical benefits in a cost-effective manner.
AHRQ-funded; HS021686.
Citation: Gallego CJ, Shirts BH, Bennette CS .
Next-generation sequencing panels for the diagnosis of colorectal cancer and polyposis syndromes: a cost-effectiveness analysis.
J Clin Oncol 2015 Jun 20;33(18):2084-91. doi: 10.1200/jco.2014.59.3665..
Keywords: Cancer, Cancer: Colorectal Cancer, Shared Decision Making, Diagnostic Safety and Quality, Genetics, Healthcare Costs, Screening
Kim DD, Hutton DW, Raouf AA
Cost-effectiveness model for hepatitis C screening and treatment: Implications for Egypt and other countries with high prevalence.
The researchers examined the cost-effectiveness of screening and treatment for HCV infection for asymptomatic, average-risk adults using a Markov decision analytic model. They found that, in Egypt, implementing a screening program using triple-therapy treatment (sofosbuvir with pegylated interferon and ribavirin) was dominant compared with no screening because it would have lower total costs and improve health outcomes.
AHRQ-funded; HS013853.
Citation: Kim DD, Hutton DW, Raouf AA .
Cost-effectiveness model for hepatitis C screening and treatment: Implications for Egypt and other countries with high prevalence.
Glob Public Health 2015;10(3):296-317. doi: 10.1080/17441692.2014.984742..
Keywords: Hepatitis, Screening, Healthcare Costs, Medication