Understanding the financial impact of covering new screening technologies. The case of automated Pap smears.
OBJECTIVE
To develop a decision tool facilitating understanding of the potential financial impact on managed care plans associated with automated primary screening for Pap smears.


METHODS
A baseline decision analytic model was developed with claims data from two managed care plans to replicate the treatment costs patients accrue subsequent to receiving a routine Pap smear with initial human review. Probabilities that a patient was at a particular decision point, as well as payments associated with that patient, were also determined empirically from the claims data. Clinical trial results for the AutoPap System (TriPath Imaging, Inc., Burlington, North Carolina) were incorporated into the model to develop an alternate scenario with 15% fewer false positives and 32% fewer false negatives. Sensitivity analyses were performed to model likely "real world" variation in laboratory results and treatment costs. Marginal costs associated with automated screening were calculated. Financial impacts were calculated in per member per month (PMPM) terms and included an incremental $20 payment for automated primary screening. Given that total PMPMs associated with health care delivery vary widely across the U.S., incremental impacts were also calculated from baseline PMPMs ranging from $80 to $160.


RESULTS
PMPMs increased 5-10 cents, depending on baseline PMPM, test performance and treatment costs.


CONCLUSIONS
Although costs rose with automated Pap smears, the costs shifted to the diagnosis and treatment of true positives.
McQuarrie
H G
HG
Public Employees Health Plan of Utah, USA.
Ogden
J
J
Costa
M
M
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D003361:Cost Allocation; D003663:Decision Trees; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000191:economics*; D019458:Insurance Coverage / Q000191:economics*; D008329:Managed Care Programs / Q000191:economics*; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D065006:Papanicolaou Test; D012680:Sensitivity and Specificity; D014481:United States; D014626:Vaginal Smears / Q000191:economics* / Q000379:methods*