Research Full Report Breast Cancer Population Screening Program Results in Early Detection and Reduced Treatment and Health Care Costs for Medicaid Sherri G. Homan, PhD, RN, FNP; Shumei Yun, PhD, MD, MPH; Adam Bouras, MSc, MHA, MSHI; Chester Schmaltz, PhD; Philomina Gwanfogbe, PhD, MSPH, CHHC; Jill Lucht, MS ABSTRACT Context: The National Breast and Cervical Cancer Early Detection Program has increased access to screening services for low-income females since 1991; however, evaluation information from states implementing the program is sparse. This study evaluates the impact of the Missouri program, Show Me Healthy Women (SMHW), on early detection and treatment cost. Objective: To estimate breast cancer treatment and health care services costs by stage at diagnosis among Missouri’s Medicaid benefciaries and assess the SMHW program impact. Design: Analyzed Missouri Medicaid claims linked with Missouri Cancer Registry data for cases diagnosed 2008-2012 (N = 1388) to obtain unadjusted and incremental costs of female breast cancer treatment and follow-up care at 6, 12, and 24 months following diagnosis. Noncancer controls (N = 3840) were matched on age, race, and disability to determine usual health care cost. Regression analyses estimated the impact of stage at diagnosis on expenditures and incremental cost. Show Me Healthy Women participants were compared with other breast cancer patients on stage at diagnosis. A comparison of SMHW participants to themselves had they not been enrolled in the program was analyzed to determine cost savings. Results: Expenditures increased by stage at diagnosis from in situ to distant with unadjusted cost at 24 months ranging from $50 245 for in situ cancers to $152 431 for distant cancers. Incremental costs increased by stage at diagnosis from 6 months at $7346, $11859, $21 501, and $20235 for in situ, localized, regional, and distant breast cancers, respectively, to $9728, $17 056, $38 840, and $44 409 at 24 months. A signifcantly higher proportion of SMHW participants were diagnosed at an early stage resulting in lower unadjusted expenditures and cost savings. Conclusions: Although breast cancer treatment costs increased by stage at diagnosis, the population screening program’s signifcant impact on early diagnosis resulted in important cost savings over time for Medicaid. KEY WORDS: breast cancer, health care costs, Medicaid, treatment Author Affliations: Missouri Department of Health and Senior Services, Division of Community and Public Health, Offce of Epidemiology, Jefferson City, Missouri (Drs Homan and Gwanfogbe); Missouri Department of Mental Health, Jefferson City, Missouri (Dr Yun); School of Medicine, Department of Health Management and Informatics, University of Missouri, Columbia, Missouri (Mr Bouras and Dr Schmaltz); Offce of Social and Economic Data Analysis, University of Missouri, Columbia, Missouri (Mr Bouras); Missouri Cancer Registry and Research Center, University of Missouri, Columbia, Missouri (Dr Schmaltz); and Center for Health Policy, University of Missouri, Columbia, Missouri (Ms Lucht). The authors thank Sujha Subramanian for her consultations and the University of Missouri Center for Health Policy, Missouri Department of Social Services’ MO HealthNet Division, Missouri Cancer Registry and Research Center, and the Missouri Department of Health and Senior Services staff for their collaborative efforts in making this project possible. This study was supported by the Consolidated Cancer Prevention Cooperative Agreement Number, NU58DP003924, funded by the Centers for Disease Control and Prevention to the Missouri Department of Health and Senior Services. Its contents are solely the responsibility of the authors and do not necessarily represent the offcial views of the Centers for Disease Control and Prevention or the Department of Health & Human Services. B reast cancer is the most frequent cancer diag- nosed among women in the United States and Missouri, excluding skin cancer. 1,2 In 2017, it was estimated that female breast cancer would be 15% of all new cancer cases and 6.8% of cancer deaths in the United States. 3 Breast cancer is most The authors declare that they have no fnancial relationships and no conficts of interest to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (http://www.JPHMP.com). Correspondence: Sherri G. Homan, PhD, RN, FNP, Missouri Department of Health and Senior Services, Division of Community and Public Health, Offce of Epidemiology, 920 Wildwood Dr, Jefferson City, MO 65102 (Sherri.Homan@health.mo.gov). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/PHH.0000000000001041 Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. 00 2019 • Volume 00, Number 00 www.JPHMP.com 1