title: Current national health insurance policies for thyroid cancer prophylactic surgery in the United States.
abstract: The efficacy of prophylactic thyroidectomy in patients with positive RET mutational analysis, familial thyroid cancer, or both has been reported. As cost has become critical to medical decision-making, this study was designed to evaluate currently existing coverage policies for prophylactic thyroidectomy. A confidential detailed cross-sectional nationwide survey of 481 medical directors from the American Association of Health Plans, Medicare, and Medicaid was conducted. 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 9% of private plans have specific policies for coverage of prophylactic thyroidectomy for patients with a strong family history of thyroid cancer, 19% provided no coverage, and 72% had no policy. Only 9% of private plans have specific policies for patients with a known thyroid cancer genetic mutation, 12% provided no coverage, and 79% had no policy. Governmental carriers were less likely to provide coverage for prophylactic surgery: 4% for a strong family history and 6% for a genetic mutation. Altogether, 52% of government carriers provided no coverage for patients with a strong family history, and 50% provided no coverage in patients with a known genetic mutation; 44% of governmental carriers had no policy for either clinical scenario. Limited health insurance coverage for prophylactic thyroidectomy is offered in both private and governmental plans, with variations in coverage. As genetic testing becomes more widespread and with the potential identification of a gene predisposing to familial nonmedullary thyroid cancer, more uniform policies should be established to enable appropriate high risk candidates broader, equal coverage and access to these procedures.
authors.affiliation: Department of Surgical Oncology, Section of Endocrine Surgery, Princess Margaret Hospital, Mount Sinai Hospital, University of Toronto, 610 University Avenue, Ontario, Canada M5G 2M9. alan.dackiw@uhn.on.ca
authors.forename: Alan P B
authors.initials: AP
authors.lastname: Dackiw
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
authors.forename: Orlo H
authors.initials: OH
authors.lastname: Clark
mesh_terms: D017558:Elective Surgical Procedures / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013964:Thyroid Neoplasms / Q000235:genetics / Q000517:prevention & control / Q000601:surgery*; D013965:Thyroidectomy / Q000191:economics*; D014481:United States