Out of Pocket Costs for Follow-Up Tests After Abnormal Screening Mammogram and Their Impact on Breast Cancer Survival

Today, the American Cancer Society’s Cancer Action Network released a report titled “Out of Pocket Costs for Follow-Up Tests After Abnormal Screening Mammogram and Their Impact on Breast Cancer Survival.” The empirical analysis was conducted by myself and some colleagues at FTI Consulting (Shanshan Wang, Shurui Zhang, Citseko Staples Miller, and Sophia Mildred Setterberg). An excerpt from the executive summary is below:

The American Cancer Society Cancer Action Network (ACS CAN) partnered with FTI Consulting to perform an economic analysis estimating the impact of cost sharing on follow-up breast cancer imaging and diagnostic testing after a screening mammogram. In addition, we used a simulation modeling approach to examine how out-of-pocket costs impact patients’ timely access to follow-up breast cancer diagnostic testing and treatment.

Our study shows that 70.4% of insured patients had to pay out-of-pocket costs for follow-up breast cancer diagnostic tests in 2023. Patients who enrolled in a high-deductible plan had the highest out-of- pocket costs. The data also noted a geographic variation with the lowest out-of-pocket costs for those residing in the eastern U.S.

Eliminating cost sharing for diagnostic testing following a mammogram would not only reduce costs to patients but also would improve health outcomes. Our analysis found that out-of-pocket cost sharing is estimated to result in 1.1 million women delaying necessary breast cancer diagnostic testing and imaging in 2024 due to affordability issues. Just as alarming, out-of-pocket costs appear to have an impact on future screening. Approximately 378,000 more women are likely to skip future mammograms in 2024 due to fear of subsequent out-of-pocket cost sharing from follow-up diagnostic tests. This study estimated that eliminating patient cost sharing would lead to 7,568 fewer patients diagnosed with later stage (i.e., regional or distant) breast cancer. Moreover, diagnosing breast cancer earlier would save $11,434 per patient diagnosed with breast cancer and more than $2 billion across all patients over their lifetime.

You can read the full report here.