Reporting the results of cystic fibrosis carrier screening

Article Abstract:

Screening partners in succession to determine if their children are at risk for cystic fibrosis may be a cost-effective and efficient means of screening. The discovery of the gene for cystic fibrosis has made it possible to screen the population for cystic fibrosis carriers. Cystic fibrosis is an autosomal recessive disease which means that both parents must at least be carriers of the disease for a child to be affected. Three screening strategies were evaluated: (A) test both partners simultaneously and report all results; (B) test partners in succession and test second partner only if first is positive, reporting all results; (C) like B, except that results are reported positive if both partners are positive and negative otherwise. Strategy A provides partners with the most information and overall costs about $860,000 per cystic fibrosis birth avoided. Overall, both strategies B and C cost about $450,000 per cystic fibrosis birth avoided, but strategy B provides partners with more information than strategy C.

Methods, Medical screening, Health screening, Cystic fibrosis

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Why some health policies don't make sense at the bedside

Article Abstract:

Health care policy makers may need to be more sensitive to the individual nature of the physician and patient relationship. Decisions in group risk management and cost-effectiveness are being made at regional levels possibly at the expense of the individual patient. Applying the theories of stock diversification and cattle management to health care policy development may be inappropriate. As a portfolio manager or cattle veterinarian might look at group dynamics, health care policy makers are increasingly looking to the outcome of the group rather than to that of the individual patient. Combining an assortment of tactics, acknowledging each patient's risk, and carefully calculating treatment options may be the best guide to establishing health care policy.

Medical care, Medical care utilization, Medical policy, Health policy

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Barriers to Office-Based Screening Sigmoidoscopy: Does Reimbursement Cover Costs?

Article Abstract:

Flexible sigmoidoscopy to screen for colorectal cancer may by underutilized because physicians do not feel they are adequately compensated for the procedure. Examination of the colon with a flexible scope can detect colon cancer early and may reduce mortality from the disease. The total cost to a physician to perform the diagnostic procedure is about $87, virtually identical to Medicare's reimbursement for the procedure. However, the cost of a procedure that includes the ability to biopsy suspect colon lesions is about $152, substantially more than Medicare reimburses physicians.

United States, Economic aspects, Colorectal cancer, Medicare, Sigmoidoscopy

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