Study Links CAD Use To Medicare Money

Is it really a big surprise that a University of California, Davis researcher has found that the use of computer-aided detection (CAD) in association with mammograms has soared since Medicare began paying for it—even though “systemic reviews point to uncertainty regarding whether CAD has a clinically important impact on key breast cancer outcomes”?

A UC Davis news release describes the research as “a study illustrating the potentially powerful influence of political pressure on medical practice.”

Joshua Fenton, MD, assistant professor in the Department of Family and Community Medicine, along with colleagues from the universities of Washington and Minnesota, said the usage of CAD to help radiologists interpret mammograms increased from 5 percent in 2001, when Medicare began covering it, to 27 percent in 2003, the most recent year for which data were available.  The Archives of Internal Medicine published the study results on Monday.

The study says Medicare paid $19.5 million in extra fees for CAD use in 2003. It adds that actual costs are probably greater because CAD is associated with higher recall rates of mammogram patients for biopsies and other diagnostic tests. In an earlier study published in the New England Journal of Medicine in 2007, Dr. Fenton and colleagues found that CAD produced an excess of false positives, which meant that 32% more women were recalled for more testing and 20% more had breast biopsies. However, according to that study, the use of CAD had no clear effect on the early detection of breast cancer.

Dr. Fenton suggested that intense lobbying by manufacturers of CAD technology, along with the fact that breast cancer screening is a hot political issue, led to fast-track approval of Medicare coverage of CAD, which Congress mandated in 2001. Without such coverage, he said, it would have been difficult to market the expensive (more than $100,000) device to hospitals and other health-care facilities. He charged:

This illustrates how industry and government interact to determine the course of health-care practice, and it’s not really guided by science. This is a case in which expensive technology gets widely adopted in clinical practice before it is proven effective.

Public concern and controversy over health-care costs show no sign of slackening, so these sorts of debates are likely to intensify. Dr. Fenton laid out his position thus: “This argues that we need a way of evaluating technologies before we put them into practice. The government has a huge stake in this. And once the train leaves the station, it’s difficult to call it back.”

Related seminar: Breast & Women’s Imaging Seminar