title: The cost implications of prostate cancer screening in the Medicare population.
abstract: BACKGROUND
  Recent debate about prostate-specific antigen (PSA)-based testing for prostate cancer screening among older men has rarely considered the cost of screening.
  
  
  METHODS
  A population-based cohort of male Medicare beneficiaries aged 66 to 99 years, who had never been diagnosed with prostate cancer at the end of 2006 (n = 94,652), was assembled, and they were followed for 3 years to assess the cost of PSA screening and downstream procedures (biopsy, pathologic analysis, and hospitalization due to biopsy complications) at both the national and the hospital referral region (HRR) level.
  
  
  RESULTS
  Approximately 51.2% of men received PSA screening tests during the 3-year period, with 2.9% undergoing biopsy. The annual expenditures on prostate cancer screening by the national fee-for-service Medicare program were $447 million in 2009 US dollars. The mean annual screening cost at the HRR level ranged from $17 to $62 per beneficiary. Downstream biopsy-related procedures accounted for 72% of the overall screening costs and varied significantly across regions. Compared with men residing in HRRs that were in the lowest quartile for screening expenditures, men living in the highest HRR quartile were significantly more likely to be diagnosed with prostate cancer of any stage (incidence rate ratio [IRR] = 1.20, 95% confidence interval [CI] = 1.07-1.35) and localized cancer (IRR = 1.30, 95% CI = 1.15-1.47). The IRR for regional/metastasized cancer was also elevated, although not statistically significant (IRR = 1.31, 95% CI = 0.81-2.11).
  
  
  CONCLUSIONS
  Medicare prostate cancer screening-related expenditures are substantial, vary considerably across regions, and are positively associated with rates of cancer diagnosis.
authors.affiliation: Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, Connecticut.
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Ma
authors.forename: Rong
authors.initials: R
authors.lastname: Wang
authors.forename: Jessica B
authors.initials: JB
authors.lastname: Long
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Soulos
authors.forename: James B
authors.initials: JB
authors.lastname: Yu
authors.forename: Danil V
authors.initials: DV
authors.lastname: Makarov
authors.forename: Heather T
authors.initials: HT
authors.lastname: Gold
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods; D006801:Humans; D007610:Kallikreins / Q000032:analysis*; D008297:Male; D006278:Medicare / Q000191:economics*; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000191:economics*; D018426:SEER Program; D014481:United States
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: cost; prostate cancer; prostate-specific antigen; screening; stage