Advanced imaging among health maintenance organization enrollees with cancer.
OBJECTIVE
Fee-for-service (FFS) Medicare expenditures for advanced imaging studies (defined as computed tomography [CT], magnetic resonance imaging [MRI], positron emission tomography [PET] scans, and nuclear medicine studies [NM]) rapidly increased in the past two decades for patients with cancer. Imaging rates are unknown for patients with cancer, whether under or over age 65 years, in health maintenance organizations (HMOs), where incentives may differ.


METHODS
Incident cases of breast, colorectal, lung, prostate, leukemia, and non-Hodgkin lymphoma (NHL) cancers diagnosed in 2003 and 2006 from four HMOs in the Cancer Research Network were used to determine 2-year overall mean imaging counts and average total imaging costs per HMO enrollee by cancer type for those under and over age 65.


RESULTS
There were 44,446 incident cancer patient cases, with a median age of 75 (interquartile range, 71-81), and 454,029 imaging procedures were performed. The mean number of images per patient increased from 7.4 in 2003 to 12.9 in 2006. Rates of imaging were similar across age groups, with the exception of greater use of echocardiograms and NM studies in younger patients with breast cancer and greater use of PET among younger patients with lung cancer. Advanced imaging accounted for approximately 41% of all imaging, or approximately 85% of the $8.7 million in imaging expenditures. Costs were nearly $2,000 per HMO enrollee; costs for younger patients with NHL, leukemia, and lung cancer were nearly $1,000 more in 2003.


CONCLUSIONS
Rates of advanced imaging appear comparable among FFS and HMO participants of any age with these six cancers.
Group Health Research Institute; Fred Hutchison Cancer Research Center, Seattle, WA; The Center for Health Research, Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, WI; Dana-Farber Cancer Institute-Harvard University, Boston, MA; and Institute for Health Research, Kaiser Permanente Colorado, Denver, CO Loggers.e@ghc.org.
Elizabeth T
ET
Loggers
Group Health Research Institute; Fred Hutchison Cancer Research Center, Seattle, WA; The Center for Health Research, Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, WI; Dana-Farber Cancer Institute-Harvard University, Boston, MA; and Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.
Paul A
PA
Fishman
Group Health Research Institute; Fred Hutchison Cancer Research Center, Seattle, WA; The Center for Health Research, Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, WI; Dana-Farber Cancer Institute-Harvard University, Boston, MA; and Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.
Do
D
Peterson
Group Health Research Institute; Fred Hutchison Cancer Research Center, Seattle, WA; The Center for Health Research, Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, WI; Dana-Farber Cancer Institute-Harvard University, Boston, MA; and Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.
Maureen
M
O'Keeffe-Rosetti
Group Health Research Institute; Fred Hutchison Cancer Research Center, Seattle, WA; The Center for Health Research, Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, WI; Dana-Farber Cancer Institute-Harvard University, Boston, MA; and Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.
Caprice
C
Greenberg
Group Health Research Institute; Fred Hutchison Cancer Research Center, Seattle, WA; The Center for Health Research, Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, WI; Dana-Farber Cancer Institute-Harvard University, Boston, MA; and Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.
Mark C
MC
Hornbrook
Group Health Research Institute; Fred Hutchison Cancer Research Center, Seattle, WA; The Center for Health Research, Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, WI; Dana-Farber Cancer Institute-Harvard University, Boston, MA; and Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.
Lawrence H
LH
Kushi
Group Health Research Institute; Fred Hutchison Cancer Research Center, Seattle, WA; The Center for Health Research, Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, WI; Dana-Farber Cancer Institute-Harvard University, Boston, MA; and Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.
Sarah
S
Lowry
Group Health Research Institute; Fred Hutchison Cancer Research Center, Seattle, WA; The Center for Health Research, Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, WI; Dana-Farber Cancer Institute-Harvard University, Boston, MA; and Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.
Arvind
A
Ramaprasan
Group Health Research Institute; Fred Hutchison Cancer Research Center, Seattle, WA; The Center for Health Research, Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, WI; Dana-Farber Cancer Institute-Harvard University, Boston, MA; and Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.
Edward H
EH
Wagner
Group Health Research Institute; Fred Hutchison Cancer Research Center, Seattle, WA; The Center for Health Research, Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, WI; Dana-Farber Cancer Institute-Harvard University, Boston, MA; and Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.
Jane C
JC
Weeks
Group Health Research Institute; Fred Hutchison Cancer Research Center, Seattle, WA; The Center for Health Research, Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, WI; Dana-Farber Cancer Institute-Harvard University, Boston, MA; and Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.
Debra P
DP
Ritzwoller
D000368:Aged; D000369:Aged, 80 and over; D003952:Diagnostic Imaging / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D018588:Fee-for-Service Plans; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare; D009369:Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D014481:United States / Q000453:epidemiology