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Indirect costs kept women from using free mammograms
Only 13.2% of eligible women took advantage of federal program.
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Researchers at the CDC have concluded that transactional and opportunity costs discouraged low-income women from getting screened for breast cancer through the National Breast and Cervical Cancer Early Detection Program.
Results were published in a recent issue of Cancer.
The program covers all the costs for clinical services including screening, breast exams, diagnostic follow-up and case management for women who are at or below 250% of federal poverty guidelines. Congress established the program in 1990 in an attempt to cut mortality rates for breast cancer by 16% to 30%.
The researchers wanted to learn why only 13.2% of eligible women had used the program. They found that opportunity costs, such as travel and wait time and time away from work, as well as transactional costs such as transportation expenses and childcare, were the stumbling blocks. Opportunity costs made up greater than 70% of each woman’s expenses.
“It’s all about time,” Donatus Ekwueme, PhD, senior health economist with the Division of Cancer Prevention and Control at the CDC, told HemOnc Today.
The researchers conducted telephone surveys of women who had used the program and culled data from the Survey of Mammography Rescreening, a retrospective cohort study of women in Maryland, New York, Ohio and Texas who used the program in 1997. Responses from 1,870 women aged between 50 and 64 years were included.
Using that information, the researchers created a decision analysis model for women earning <$10,000 annually and for those earning between $10,000 and <$20,000. They created a formula that included all the resources each woman needed to participate in the screening program and the amount of each resource used. Lastly, they assigned a monetary value to each of those resources and used that formula to calculate the costs each woman incurred for both a onetime screening and during the course of her life. The results were then stratified by race.
All costs were standardized to 2000 U.S. dollars.
The estimated cost to obtain a free mammogram for a woman earning <$10,000 was $17.45. Based on the assumption she would get screened once every 2.5 years, her discounted lifetime cost was $108.47 for 10 screenings and $261.60 for 25 screenings.
Women earning from $10,000 to <$20,000 spent $31.19 in onetime costs, $196.67 for 10 screenings and $474.55 for 25 screenings (see chart).
Cost in Dollars Associated With Mammography for Low-Income Women in the National Breast and Cervical Cancer Early Detection Program |
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Non-Hispanic white women incurred the highest costs of any racial or ethnic group in both income strata. The onetime screening cost for a white woman making ,$10,000 was $6.82 and $12.60 for a white woman making from $10,000 to ,$20,000.
“That was somewhat expected,” Ekwueme said. “The non-Hispanic white woman is probably making more money per hour. Leaving work to go for screening is likely costing her more, and her childcare costs are probably higher.”
The researchers said the best way to get women to use the program was to address these opportunity costs. Ekwueme recommended compensating women for their time and bringing mammography to women where they live or work.
“One alternative would be mobile mammography,” he said. “That’s one way to reduce the opportunity costs. Incentive, in all aspects, is a driving force.” – by Jason Harris
Cancer. 2008;doi:10.1002/cncr.23613.