Cover: Caring for the Uninsured with Prostate Cancer

Caring for the Uninsured with Prostate Cancer

A Comparison of Four Policy Alternatives in California

Published In: Journal of Community Health, v. 35, no. 1, Feb. 2010, p. 18-26

Posted on on January 01, 2010

by Jonathan Bergman, Susan Logan, Arlene Fink, David A. Ganz, Mark A. Peterson, Mark Litwin

The IMPACT Program seeks to improve access to prostate cancer care for low-income, uninsured men. The objective of the current study was to compare the cost-effectiveness of four policy alternatives in treating this population. The authors analyzed the cost-effectiveness of four policy alternatives for providing care to low-income, uninsured men with prostate cancer: (1) IMPACT as originally envisioned, (2) a version of IMPACT with reduced physician fees, (3) a hypothetical Medicaid prostate cancer treatment program, and (4) the existing county safety net. They calculated cost-effectiveness based on incremental cost-effectiveness ratios (ICERs) with the formula ICER = (Costalternative strategy ? Costbaseline strategy) / (QALYalternative strategy ? QALYbaseline strategy). The authors measured outcomes as quality-adjusted life years (QALYs). Best-case scenarios assumed timely access to care in 50% of cases in the county system and 70% of cases in any system that reimbursed providers at Medicaid fee-for-service rates. Worst-case scenarios assumed timely access in 35 and 50% of corresponding cases. In fiscal year 2004-2005, IMPACT allocated 11% of total expenditures to administrative functions and 23% to fixed clinical costs, with an overall budget of $5.9 million. The ICERs ($/QALY) assuming best-case scenarios for original IMPACT, modified IMPACT, and a hypothetical Medicaid program were $32,091; $64,663; and $10,376; respectively. ICERs assuming worst-case scenarios were $27,189; $84,236; and $10,714; respectively. County safety net was used as a baseline. In conclusion, IMPACT provides underserved Californians with prostate cancer care and value-added services with only 11% of funds allocated to administrative fixed costs. Both the original IMPACT program and the hypothetical Medicaid prostate cancer program were cost-effective compared to the county safety net, while the reduced-fees version of IMPACT was not.

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