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Impact of the 2008-2009 economic recession on screening colonoscopy utilization among the insured.

ABSTRACT: Economic factors might affect the use of recommended preventative services. We sought to determine whether the recent severe economic recession was associated with diminished screening colonoscopy rates among an insured population and to assess the relationship between out-of-pocket (OOP) costs and screening colonoscopy use.Administrative data from 106 health plans (IMS LifeLink Health Plan Claims Database) were analyzed to determine monthly rates of screening colonoscopies performed on beneficiaries ages 50 to 64 years between January 2005 and November 2007 (prerecession), as well as from December 2007 through June 2009 (recession). Segmented regression models were used to evaluate changes in screening colonoscopy rates, as well as the relationship between screening and OOP costs before and during the recession.Compared with prerecession trends, during the recession screening colonoscopy rates decreased by 68.9 colonoscopies/1 million individuals per month (95% confidence interval, -84.6 to -53.1; P < .001). Application of study estimates to the entire US population indicated that during the recession, commercially insured patients aged 50 to 64 years underwent approximately 500,000 fewer screening colonoscopies. Compared with those with low OOP costs, those with high OOP procedure costs had lower rates of screening before and during the recession, and had a greater reduction in screening rates during the recession (P = .035).During the recession of December 2007 to June 2009, insured individuals reduced their use of screening colonoscopy compared with the 2 years before the recession began. OOP costs were related inversely to screening use, especially during the recession. Policies to reduce cost sharing could increase adherence to recommended preventive services such as colonoscopy examinations.

SUBMITTER: Dorn SD

PROVIDER: S-EPMC4566928 | biostudies-literature | 2012 Mar

REPOSITORIES: biostudies-literature

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Impact of the 2008-2009 economic recession on screening colonoscopy utilization among the insured.

Dorn Spencer D SD Wei David D Farley Joel F JF Shah Nilay D ND Shaheen Nicholas J NJ Sandler Robert S RS Kappelman Michael D MD

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 20111207 3

<h4>Background & aims</h4>Economic factors might affect the use of recommended preventative services. We sought to determine whether the recent severe economic recession was associated with diminished screening colonoscopy rates among an insured population and to assess the relationship between out-of-pocket (OOP) costs and screening colonoscopy use.<h4>Methods</h4>Administrative data from 106 health plans (IMS LifeLink Health Plan Claims Database) were analyzed to determine monthly rates of scr ...[more]

PMID: 22155558

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Project description:BACKGROUND:The economic recession of 2008-2009 resulted in unprecedented employment and economic losses leading to deterioration of cardiovascular health. We examined the trends in ideal cardiovascular health as measured by the American Heart Association's (AHA's) Life's Simple 7 metric during the periods of economic recession and subsequent economic recovery. METHODS:Data on adults ages ?20 years from the NHANES from economic-recession (2007-2010) and post-recession (2011-2016) periods was analyzed. The AHA's Life's Simple 7 score of 10-14 was used to classify ideal cardiovascular health status. Socioeconomic status was divided into 3 categories: high, middle, and low based on education and income status. Multivariable linear and logistic regression models including demographics, insurance status, health care access, and adjustment for multiple testing were used to analyze the trends in prevalence of ideal cardiovascular health across socioeconomic strata. RESULTS:We observed a decline in the multivariable-adjusted mean cardiovascular health score from 8.18 in 2007-2010 to 7.94 in 2015-2016 (Plinear = 0.02). This was primarily driven by the increasing prevalence of obesity (34% in 2007-2010 vs 41% in 2015-2016, Plinear = 0.005) and poor fasting glucose (8% in 2007-2010 vs 12% in 2015-2016, Plinear = 0.003). In multivariable-adjusted models, we observed the decreasing prevalence of ideal cardiovascular health with a nonlinear trend in the participants in the highest (51% in 2007-2010 vs 42% in 2015-2016, Pquadratic = 0.01) and lowest socioeconomic strata (16% in 2007-2010 vs 13% in 2015-2016, Pquadratic = 0.02). The prevalence of ideal cardiovascular health was higher in participants with high-socioeconomic status compared with other socioeconomic status participants. CONCLUSIONS:Despite economic recovery, ideal cardiovascular health metrics have not yet recovered. Cardiovascular health appears to be further deteriorating for US adults, particularly those in high- and lower-socioeconomic strata.

Project description:INTRODUCTION:Despite the well-known link between stress and smoking, evidence for associations between economic recession, financial stress, and smoking is contradictory. In this study, we assess whether women were more likely to continue smoking during pregnancy if they were exposed to the UK 2008-2010 economic recession during pregnancy than those who were unexposed, and whether this relationship is mediated by financial stress. METHODS:We used cross-sectional data on 2775 pregnant women who were regular smokers before pregnancy and who were enrolled in the UK Born in Bradford cohort study between March 2007 and December 2010. The cutoff date for exposure to recession was set as August 1, 2008, based on local and national economic data. Multivariable logistic regression analysis included potential confounders: maternal age, parity, cohabitation, ethnicity, and maternal age. The mediating role of financial stress was analyzed using "worse off financially" and a "difficult financial situation" as indicators of financial stress in Sobel-Goodman mediation tests with bootstrap resampling. RESULTS:After taking into account potential confounders, exposure to recession was associated with continued smoking during pregnancy (OR = 1.19, 95% CI = 1.01 to 1.41, p = 0.03). A worse financial situation and a difficult financial situation were identified as mediators, explaining 8.4% and 17.6%, respectively, of the relationship between exposure to recession and smoking during pregnancy. CONCLUSIONS:Smoking during pregnancy is associated with exposure to the UK 2008-2010 economic recession during pregnancy, and this relationship is partly mediated by financial stress. IMPLICATIONS:Health inequalities in smoking during pregnancy are affected by economic recession, as those who are most likely to smoke are also most likely to experience the financial stress resulting from economic recession. Socioeconomic conditions at the societal and individual level are important targets when aiming to reduce rates of smoking during pregnancy.

Project description:BackgroundComputed tomography (CT) colonography's effectiveness, its associated patient advantages, and its potential role to increase colorectal cancer (CRC) screening rates have been demonstrated in previous research, but whether CT colonography has a cost advantage relative to optical colonoscopy for the commercially insured US population has not been assessed.ObjectiveTo compare the costs of CRC screening using CT colonography or optical colonoscopy for commercially insured people in the United States.MethodsUsing retrospective commercial healthcare claims data and peer-reviewed studies, we performed a simulated multiyear, matched-case comparison of the costs of CT and optical colonoscopies for CRC screening. We estimated commercial optical colonoscopy costs per screening based on the 2016 Truven Health MarketScan Commercial Database and ancillary services, such as bowel preparation, anesthesia, pathology, and complication costs. We developed 4 scenarios for CT colonography cost per screening using the ratio of commercial to Medicare fees, and calculated ancillary service and follow-up costs from payers' costs for these services when associated with optical colonoscopies. For comparison, we converted the costs per screening to the costs per screening year per person using real-world screening intervals that were obtained from peer-reviewed studies.ResultsIn 2016, the average optical colonoscopy screening cost for commercial payers was $2033 (N = 406,068), or $340 per screening year per person. With our highest-cost CT colonography scenario, CT colonography costs 22% less, or $265 per screening year, than optical colonoscopy, mostly because of the advantages for patients of no anesthesia and the greatly reduced use of pathology services.ConclusionsThe use of CT colonography for CRC testing offers effective screening, patient-centered advantages, and lower costs compared with optical colonoscopy, and may be particularly appealing to the currently unscreened population with commercial health insurance. If the availability of CT colonography expands to meet the increased demand for it, CT colonography could cost up to 50% less than optical colonoscopy per screening year.

Project description:Background and aimColonoscopy is the gold-standard screening test for colorectal cancer. However, it has come under scrutiny for its carbon footprint and contribution to greenhouse gas (GHG) emissions compared to other medical procedures. Notwithstanding, screening colonoscopies may have a positive effect on GHG emissions that is unknown. This study estimated the carbon emissions prevented by screening colonoscopies in the U.S.MethodsUsing the reported number of screening colonoscopies performed annually in the U.S. and the absolute risk reduction (ARR) reported in the NorDICC trial, we calculated the expected minimum number of cancer treatment and surveillance visits prevented through screening based on the cancer stage. The average carbon emission averted per mile traveled was computed using the Environmental Protection Agency's (EPA) GHG equivalencies calculator. The final estimate of carbon emissions averted over a decade by screening colonoscopies performed in one year was determined.Result6.3 million screening colonoscopies performed in one year prevent 1,134,000 colorectal cancers over a ten-year period. Of these, 38∙3% (434,254) are localized, 38∙8% (440,281) are regional, and 22∙9% (259,465) are metastatic disease. The minimum number of post-diagnosis visits prevented is 11 for stage I, ≥ 21 for stage II, ≥25 for stage III, and ≥ 20 for stage IV disease, comprised of diagnostic, surgical evaluation, chemotherapy, and surveillance visits. The total number of visits prevented by screening is 2,388,397 for stage I, 5,254,421 for stage II, 13,120,369 for stage III, and 9,210,972 for stage IV disease. Approximately 395 million miles of travel and 158,263 metric tons of CO2, equivalent to 177 million pounds of coal burned, 19 billion smartphones charged, or 18 million gallons of gasoline consumed, were saved over ten years through screening.ConclusionColorectal cancer screening decreases cancer-related GHG emissions and minimizes the environmental impact of cancer treatment.

Dataset Information

Impact of the 2008-2009 economic recession on screening colonoscopy utilization among the insured.

Publications

Impact of the 2008-2009 economic recession on screening colonoscopy utilization among the insured.

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