When a free cancer check finds something, could cost keep patients from following up?

Two new studies show potential out-of-pocket costs for tests in patients after initial screening for lung and cervical cancer.

5:00 AM

Author | Kara Gavin

lab notes general image of stethoscope drawn in blue ink on lined paper
Michigan Medicine

Eleven years ago this month, the scans and exams that hold the most power to spot the early signs of cancer became available for free to many American adults.

Now, two new studies show that when those screening tests reveal potentially troubling signs, patients could face hundreds of dollars in costs for follow-up tests.

The studies, by teams from the University of Michigan and Duke University, could inform efforts to ensure that patients follow up on abnormal test results and don't delay care due to cost. Such delays could lead to cancer goes undiagnosed and progresses, potentially leading to worse patient outcomes and high medical costs.

The studies look at out-of-pocket costs billed to older adults who had CT scans to screen for lung cancer, and to women after an abnormal Pap smear or cervical exam.  

The first paper, led by radiologists Tina Tailor, M.D., from Duke and Ruth Carlos, M.D., M.S. of U-M's Michigan Medicine, looks at what patients were billed for the lung biopsies and other invasive procedures used to follow up on an abnormal lung CT scan. It's published in the Journal of the American College of Radiology.

In all, 7.4% of the patients who had a lung cancer screening CT went on to have at least one follow-up invasive procedure. While 20% of this group was diagnosed with lung cancer, the rate of procedures "downstream" of the screening CT is higher than what was seen in the clinical trials of this type of screening. Such studies established the value of lung CT screening in certain older adults and led to no-cost access in 2013.

Over half of the patients who had a procedure after their lung scan were asked to pay something, sometimes hundreds or even thousands of dollars out of their own pockets. Forty percent paid nothing for their follow-up care.

Now that more American adults are eligible for free lung cancer screening, due to new evidence about its ability to spot disease early, the authors say insurers may want to consider ways to reduce the cost burden on those with abnormal scans who need follow-up care to determine if cancer is present.

The second paper, published in the journal Obstetrics & Gynecology by a team led by U-M internal medicine professor A. Mark Fendrick, M.D., and OB-GYN assistant professor Michelle Moniz, M.D., M.Sc., looks at what women paid out of their own pockets for a type of cervical exam called colposcopy. Conducted after a Pap smear, HPV test or routine cervical exam gives abnormal results, a colposcopy can include a biopsy or other procedures.

Women who had a colposcopy without further procedures paid an average of $112, while those who had cells taken for further examination paid $155 on average. Those who had further procedures faced hundreds of dollars more in costs -- and this out-of-pocket cost rose sharply during the 13 years studied. By 2019, a woman who had additional care beyond a biopsy could expect to face a total bill of nearly $1,000.

Carlos, Fendrick and Moniz are members of the U-M Institute for Healthcare Policy and Innovation. Fendrick directs the Center for Value-Based Insurance Design.

Papers cited:

"Total and Out-of-Pocket Costs of Procedures after Lung Cancer Screening in a National Commercially Insured Population: Estimating An Episode of Care," JACR pre-proof.

"Out-of-Pocket Costs for Colposcopy Among Commercially Insured Women From 2006 to 2019," Obstetrics & Gynecology. DOI: 10.1097/AOG.0000000000004582


More Articles About: Lab Notes Cancer Screening Cancer Testing Health Care Delivery, Policy and Economics Wellness and Prevention
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories Older couple holding hands
Health Lab
In sickness and in health, older couples mostly make Medicare moves together
A new study suggests the need for more efforts to help both members of a couple weigh and choose their Medicare options together, because most changes of plan occur with both members of the couple changing from the same option to the same option.
Speculum illustration including a gloved hand holding a swab in front of microscopic cells
Health Lab
U.S. could cut cervical cancer cases, deaths by up to 20% if more patients followed up after screening, study suggests
Many women don’t get cervical cancer screening such as Pap tests, or don’t go for follow up diagnostic tests; a new study shows what could happen if all of them did.
Spilled pills next to a stethoscope and pile of cash
Health Lab
Drug pricing program improved prostate cancer treatment adherence
Socially vulnerable patients were more likely to stick with oral medications when treated at a hospital participating in 340B program, suggesting these hospitals may have more resources to help patients.
gun with lock on it with key there gun is in black and background yellow and lock is white
Health Lab
Michigan’s new firearm injury prevention laws: What everyone should know
Michigan has a set of new laws related to firearms, all designed to reduce the risk of injury and death across the state.
Woman poses with her family and after her college graduation
Health Lab
Clinical trial aims to treat HPV, cervical lesions without surgery
Patients can now enroll in a clinical trial to test a groundbreaking nonsurgical treatment for cervical lesions that affect nearly 300,000 women in the United States every year.
computer
Health Lab
Same patient. Different visit. Different race and ethnicity?
Data on the race and ethnicity of patients underpins efforts to reduce health care disparities, but a study shows inconsistent recording in emergency departments