First National Survey Uncovers OOP Disparities in Mammography Expenditures

June 2011, Vol 2, No 3 -

The first national study of average out-of-pocket (OOP) and overall mammography expenditures indicates that in 2007 and 2008, women living in the midwestern United States had an OOP expenditure that was nearly double those living in the Northeast or the West, at $47, $24, and $25, respectively, based on data presented at the 2011 International Society for Pharmacoeconomics and Outcomes Research’s annual meeting.

Women using office-based facilities had far higher OOP expenditures than those receiving mammograms at outpatient hospitals ($35 vs $28, respectively). However, overall mammography costswere higher at the outpatient hospitals ($310 vs $243, respectively).

The good news is that the average OOP mammography cost for all women was only $32.90, with average total mammography expenditures of $266.49. “This study highlights where disparities and variations exist among OOP and total expenditures for mammography, but also informs women what they can expect to pay OOP,” said principal investigator Traci LeMasters, BS, MA, research assistant, School of Pharmacy, West Virginia University, Morgantown.

“However, these are just averages for these subgroups from this particular data set.…And this also is not representative of all women aged 18 to 64, because we included women with only 1 mammogram in a year,” she added.

The investigators analyzed 2007- 2008 data froma nationally representative survey known as the Medical Expenditure Panel Survey, conducted by theAgency for Healthcare Research and Quality.

Data in the current analysis included 2020 women who received only 1 mammogram in 2007 or in 2008; of these women, 80% were white, 85.1% were not poor, and 86.8% had private insurance.

Not surprising, women who were uninsured had the greatest OOP expenditures ($60) of any of the women and paid the highest proportion of the total mammography cost (31%). In addition, OOP costs varied by region and by facility type.

Among women with insurance, those with private insurance paid $33 OOP—the highest amount and the largest proportion of total mammography expenditures (14%). Those with Medicaid coverage paid the lowest OOP, which was also the smallest proportion of total mammography costs.

Ms LeMasters is now analyzing survey data collected from women attending Bonnie’s Bus, a mobile mammography program. The bus crisscrosses West Virginia, with medical professionals on board providing mammography services to women in areas where low rates of mammography utilization and high rates of latestage breast cancer have been historically observed. Although it does not provide freemammograms, 38.6%and 34.2% of the mammograms received by women from Bonnie’s Bus in 2009 and 2010, respectively, were paid for by the West Virginia Breast and Cervical Cancer Screening Program. Such services help remove the disparities highlighted in the study, observed Ms LeMasters.