Using cost-effectiveness analysis to define a breast cancer benefits package for the uninsured.
OBJECTIVE
In 1999, California was considering legislation to fund breast cancer treatment for its uninsured. We sought to define the most cost-effective breast cancer benefits package in order to inform this debate.


METHODS
We use cost-effectiveness analysis to calculate the additional costs and benefits of various adjuvant therapy strategies, radiation after breast conserving surgery, and reconstruction compared to those of surgery alone in order to define the most cost-effective breast cancer benefits package for uninsured women.


RESULTS
Using cost-effectiveness analysis, we define a Minimum Breast Cancer Benefits Package that includes only the most cost-effective life-saving breast cancer treatments. To provide these benefits for an estimated 550 breast cancer patients will cost $10,200,000. We present two options that each cost an additional $1,700,000 - to expand the benefits to these patients to include post-mastectomy radiation and breast reconstruction; or to provide the Minimum Package to an additional 93 uninsured women.


CONCLUSIONS
California legislators must decide whether to offer comprehensive benefits to a limited number of breast cancer patients or to provide only the most life-saving treatments to a greater number of women.
Malin
Jennifer L
JL
Department of Medicine, University of California, Los Angeles 90095-1736, USA. jmalin@mednet.ucla.edu
Keeler
Emmett
E
Wang
Cynthia
C
Brook
Robert
R
D001943:Breast Neoplasms / Q000191:economics* / Q000628:therapy*; D002140:California; D017024:Chemotherapy, Adjuvant / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006291:Health Policy; D006801:Humans; D007342:Insurance Benefits / Q000191:economics*; D015412:Mastectomy, Segmental / Q000191:economics; D017057:Medically Uninsured; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D018714:Radiotherapy, Adjuvant / Q000191:economics; D019651:Plastic Surgery Procedures / Q000191:economics; D013219:State Government