Did I say in yesterday’s post that the cost per saved life for giving routine annual mammograms to women under 50 was $3.8 million ? Multiply than by five, according to Dr. Richard Shannon of the University of Pennsylvania, who was one of the featured speakers at a Consumers Union Safe Patient project confab in Washington yesterday.
Shannon, for those not familiar with his work, has done some remarkable things to reduce hospital errors, first in Pittsburgh and more recently in the City of Brotherly Love. I was another featured speaker later in the day, and during my talk, I used the mammography example to illustrate how the health care system fails to balance risk and reward from pricey interventions — like when giving mammography to women under 50 without other breast cancer risk factors like family history, obesity or smoking.
When I cited the numbers I wrote in yesterday’s post, I was a little nervous. I had used $200 per mammogram as a back-of-the-envelope guess in calculating costs. From the podium, I asked Dr. Shannon, who was sitting in the front row, is that about right ? He shook his head no. "It’s about $1,000 if you include all the costs," he said. I was relieved and depressed. The cost per saved life isn’t $3.8 million. It is closer to $20 million, and that’s still without including the cost of all the useless interventions for the false positives.
I wasn’t going to go public with that story, but then I read this morning’s New York Times story headlined "Many Doctors to Stay Course." Only at the very end of the story did the cost issue get raised :
Although the recommendations did not mention costs, Dr. Joanna Cain, a gynecologic oncologist at Women and Infants Hospital in Providence, R.I., was among doctors who said they saw value in pointing out the issue of where to spend resources.
"To catch the one extra breast cancer, are we willing to give up the funds that might fund immunization" or another health measure ? she said. "Those are real concerns. But here’s the other side of anxiety : Many of our patients have already said to us, ‘I saw that, but I’d be too anxious not to have a mammogram."
How hard would it be to come up with a dollar figure to save one life in 1,904 women screened for ten years ?
Meanwhile, the second story that sampled popular opinion on the issue gave voice to full-throated ignorance without any effort to correct misconceptions. What are we to think of a 37-year-old mother of two who thinks the U.S. Preventive Services Task Force recommendations are a plot by the Food and Drug Administration and the insurance companies, who are like the mafia with hidden motives ? The FDA has nothing to do with this (other than approving mammogram machines as safe devices) and the insurance industry faces laws in 49 states that requires insurers to pay for mammograms if ordered by a physician no matter what the guidelines say. It seems to me there is a journalistic responsibility to either ignore or flag as inaccurate such flagrantly ignorant comments.
How about the 55-year-old woman allowed to state categorically that it "doesn’t cost that much" and she sees no reason to change her pattern (the guidelines would have her tested every other year instead of every year) since there is "no significant harm or expense." Of course, there’s no significant expense to her. It’s the insurance company’s money, which means it’s everybody’s money, which means it’s nobody’s money. So why not spend it willy-nilly and let everyone’s premiums soar ?
We will never have a rational discussion about cost control in this country if even our leading paper can only cover the issue as an afterthought without solid information.
Meanwhile, the Washington Post has a much more even-handed discussion of the cost issue, allowing the chairman of the task force to rebut claims by radiologists that holding down costs was the primary motivation for the recommendations. However, the paper failed to note that the Access to Medical Imaging Coalition, which advocates for what its name implies, is wholly a creature of the x-ray equipment manufacturing industry. You’d think a paper that understand the role of astroturf lobbying groups in ginning up fake grass roots support for special interest legislation would point out that fact for its readers.
