The effect of immediate reading of screening mammograms on medical care utilization and costs after false-positive mammograms.
OBJECTIVE
To investigate whether decreased anxiety associated with immediate reading of screening mammograms resulted in lower downstream utilization and costs among women with false-positive mammograms.


METHODS
We identified 1,140 women, > or =age 40, with false-positive mammograms and 12-month follow-up after participating in a trial of immediate versus batch mammographic reading between February 1999 and January 2001 in a multispecialty group managed care practice in Massachusetts.


METHODS
We determined downstream utilization and costs for study participants by immediate and batch reading status.


METHODS
Demographic, comorbidity, and medical care utilization data were obtained from survey data and computerized medical record databases. Costs included direct medical costs, patient time, travel and copayments, and additional professional time costs associated with immediate reading.


RESULTS
Immediate reading cost an additional $4.40 per screening mammogram. Women with immediate readings had more follow-up mammograms (781 versus 750, p=.018) and fewer diagnostic ultrasounds (176 versus 219, p=.016) than women with batch readings. Costs to the health plan for breast care were approximately 10 percent higher for immediate readings in multivariable analyses (p=.046), but no significant difference was seen in total societal costs (p=.072).


CONCLUSIONS
Immediate mammogram reading was associated with increased costs to the health plan and changes in follow-up radiology procedures. These costs must be examined alongside beneficial effects of immediate reading.
Stewart
Kate A
KA
Department of Health Care Policy, 180 Longwood Avenue, Boston, MA 02115, USA.
Neumann
Peter J
PJ
Fletcher
Suzanne W
SW
Barton
Mary B
MB
D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology; D003365:Costs and Cost Analysis; D003710:Demography; D005189:False Positive Reactions; D005260:Female; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008327:Mammography / Q000191:economics* / Q000379:methods* / Q000523:psychology; D008403:Mass Screening; D008404:Massachusetts; D008875:Middle Aged; D017059:Models, Econometric; D013997:Time Factors