title: The patient burden of screening mammography recall.
abstract: OBJECTIVE
  The aim of this article is to evaluate the burden of direct and indirect costs borne by recalled patients after a false positive screening mammogram.
  
  
  METHODS
  Women aged 40-75 years undergoing screening mammography were identified from a U.S. commercial claims database. Women were required to have 12 months pre- and 6 months post-index enrollment to identify utilization and exclude patients with subsequent cancer diagnoses. Recall was defined as the use of diagnostic mammography or breast ultrasound during 6 months post-index. Descriptive statistics were presented for recalled and non-recalled patients; differences were compared using the chi square test. Out-of-pocket costs were totaled by utilization type and in aggregate for all recall utilization.
  
  
  RESULTS
  Of 1,723,139 patients with a mammography screening that were not diagnosed with breast cancer, 259,028 (15.0%) were recalled. Significant demographic differences were observed between recalled and non-recalled patients. The strongest drivers of patient costs were image-guided biopsy (mean $351 among 11.8% utilizing), diagnostic mammography ($50; 80.1%), and ultrasound ($58; 65.7%), which accounted for 29.9%, 29.0%, and 27.5% of total recall costs, respectively. For many patients the entire cost of recall utilization was covered by the health plan. Total costs were substantially greater among patients with biopsy; one-third of all patients experienced multiple days of recall utilization.
  
  
  CONCLUSIONS
  After a false positive screening mammography, recalled women incurred both direct medical costs and indirect time costs. The cost burden for women with employer-based insurance was dependent upon the type of utilization and extent of health plan coverage. Additional research and technologies are needed to address the entirety of the recall burden in diverse populations of women.
authors.affiliation: 1 Jefferson School of Population Health , Philadelphia, Pennsylvania.
authors.forename: Matthew
authors.initials: M
authors.lastname: Alcusky
authors.forename: Liane
authors.initials: L
authors.lastname: Philpotts
authors.forename: Machaon
authors.initials: M
authors.lastname: Bonafede
authors.forename: Janice
authors.initials: J
authors.lastname: Clarke
authors.forename: Alexandria
authors.initials: A
authors.lastname: Skoufalos
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000191:economics* / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control; D017281:Cost of Illness; D055088:Early Detection of Cancer; D005189:False Positive Reactions; D005260:Female; D017048:Health Care Costs; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008327:Mammography / Q000191:economics* / Q000523:psychology / Q000706:statistics & numerical data; D008403:Mass Screening / Q000191:economics* / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D012959:Socioeconomic Factors; D013997:Time Factors