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Cancer > Cancer Screening > Reducing Out-of-Pocket Costs
Client-oriented Cancer Screening Interventions:
Reducing Out-of-Pocket Costs
On behalf of the Task Force on Community Preventive Services, a team of subject matter specialists and other scientists conducted a systematic review of published studies evaluating the effectiveness of small media in increasing screening for breast, cervical and colorectal cancer.
The Task Force recommends interventions that reduce out-of-pocket costs to clients based on evidence of effectiveness, in increasing:
- breast cancer screening by mammography.
The Task Force concluded there was insufficient evidence to determine the effectiveness of reducing out-of-pocket costs to increase:
- cervical cancer screening by Pap test, and
- colorectal cancer screening by fecal occult blood testing (FOBT), flexible sigmoidoscopy, colonoscopy, or double contrast barium enema.
- Interventions to reduce out-of-pocket costs decrease the cost of cancer screening or its administration directly, through insurance coverage, or by reducing clients’ co-payments for screening services.
- These interventions can include:
- providing vouchers to pay part of the fee for screening tests
- reducing the costs of the screening tests
- reimbursing clients or clinics for completed screenings, or
- changing the cost of federal or state insurance coverage.
- These interventions are based on the idea that reducing the cost of screening will:
- increase demand for and use of the services
- increase repeat cancer screening, and
- increase the likelihood of clients following the recommended cancer screening schedule.
Breast Cancer: Reducing Out-of-Pocket Costs is Recommended to Increase Screening
Findings from the Systematic Review
- Eight studies that qualified for the systematic review demonstrated a median 12.5 percentage point post-intervention increase in completed mammography after out-of-pocket costs were reduced.
- Reducing out-of-pocket costs to increase breast cancer screening by mammography should be applicable in various populations and settings where people would accept screening if they could afford to pay for the services.
Cervical Cancer: More Evidence is Needed to Determine the Effectiveness of Reducing Out-of-Pocket Costs to Increase Screening
Findings from the Systematic Review
- The one study that qualified for the systematic review reported a 17 percentage point increase in Pap test completion.
- This single study provided insufficient evidence to determine the effectiveness of reducing out-of-pocket costs in increasing cervical cancer screening by Pap test.
Colorectal Cancer: More Evidence is Needed to Determine the Effectiveness of Reducing Out-of-Pocket Costs to Increase Screening
Findings from the Systematic Review
- The evidence was insufficient to determine the effectiveness of reducing out-of-pocket costs in increasing colorectal cancer screening by fecal occult blood test, flexible sigmoidoscopy, colonoscopy, or double contrast barium enema, because no studies evaluating these procedures were found.
Prior to and during the literature review and data analysis, the review team and the Task Force on Community Preventive Services attempt to address the key questions of what interventions work, for whom, under what conditions, and at what cost. Lack of sufficient information often leaves one or more of these questions unanswered. The Community Guide refers to these as “research gaps". Research gaps are pulled together in the form of a basic set of questions to inform a research agenda for those in the field. Each completed Community Guide review includes a section on research gaps (or issues) and this is included in final evidence review publications.
Cancer is a major public health problem in the United States. For more information on the scope of this problem, visit Background on Screening for Breast, Cervical and Colorectal Cancers.
Evidence Review:
Baron RC, Rimer BK, Coates RJ, et al.
Client-directed interventions to increase community
access to breast, cervical, and colorectal cancer
screening: a systematic review.
Am J Prev Med 2008;35(1S):56-66.
Recommendations:
Task Force on Community Preventive
Services. Recommendations for client- and
provider-directed interventions to increase
breast, cervical, and colorectal cancer screening
Am J Prev Med 2008;35(1S):21-5.
The findings and conclusions in this report are those of the authors and the Task Force on Community Preventive Services and do not necessarily represent the official position of the CDC.
The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Client-oriented cancer screening interventions: reducing out-of-pocket costs.
www.thecommunityguide.org/cancer/screening/reducing-out-of-pocket-costs.htm.
Last Updated: MM/DD/YYYY.
Review completed: July 2008
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