Implications of the initial braidwood v. Becerra ruling for colorectal cancer outcomes: a modeling study.

IF 9.9 1区医学 Q1 ONCOLOGY

JNCI Journal of the National Cancer Institute Pub Date : 2024-10-03 DOI:10.1093/jnci/djae244

Rosita Van Den Puttelaar, Kewei Sylvia Shi, Robert Smith, Jingxuan Zhao, Margaret Katana Ogongo, Matthias Harlass, Anne I Hahn, Ann G Zauber, K Robin Yabroff, Iris Lansdorp-Vogelaar

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Abstract

The Affordable Care Act (ACA) eliminated patient cost-sharing for USPSTF recommended services. However, if the US Court of Appeals for the Fifth Circuit fully upheld a US District Court ruling in Braidwood Management v. Becerra, 666 F. Supp. 3d 613 (N.D. Tex 2023), cost-sharing for USPSTF recommendations made after ACA passage would have been reinstated for over 150 million people. The case could still reinstate cost-sharing for colorectal cancer (CRC) screening for ages 45-49 years and for polyp removal during (diagnostic) colonoscopy across all ages. Using the MISCAN-Colon model, we simulated the potential impact on CRC outcomes, assuming early-onset CRC trends, and lower screening participation. An 8-percentage-points decline in screening participation could increase CRC incidence by 5.1%, and CRC mortality by 9.1%, with slightly lower costs due to increased cost-sharing. Larger decreases in screening participation can result in higher costs from increased incidence and delayed diagnoses.

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布拉德伍德诉贝塞拉案的初步裁决对结直肠癌治疗结果的影响：一项模型研究。

平价医疗法案》（ACA）取消了 USPSTF 推荐服务的患者费用分担。然而，如果美国第五巡回上诉法院完全支持美国地区法院在 Braidwood Management 诉 Becerra，666 F. Supp. 3d 613（德克萨斯州北区，2023 年）一案中的裁决，那么超过 1.5 亿人将恢复对《可负担医疗法案》通过后 USPSTF 建议服务的费用分担。此案仍可恢复 45-49 岁人群的结直肠癌（CRC）筛查费用分担，以及所有年龄段人群在（诊断性）结肠镜检查期间的息肉切除费用分担。我们使用 MISCAN-Colon 模型模拟了对 CRC 结果的潜在影响，假设 CRC 的发病趋势较早，筛查参与率较低。筛查参与率每下降 8 个百分点，CRC 发病率就会增加 5.1%，CRC 死亡率就会增加 9.1%，而由于费用分担的增加，成本会略有降低。如果筛查参与率下降幅度较大，则会因发病率增加和诊断延迟而导致成本增加。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JNCI Journal of the National Cancer Institute 医学-肿瘤学

CiteScore

17.00

自引率

2.90%

发文量

203

审稿时长

4-8 weeks

期刊介绍： The Journal of the National Cancer Institute is a reputable publication that undergoes a peer-review process. It is available in both print (ISSN: 0027-8874) and online (ISSN: 1460-2105) formats, with 12 issues released annually. The journal's primary aim is to disseminate innovative and important discoveries in the field of cancer research, with specific emphasis on clinical, epidemiologic, behavioral, and health outcomes studies. Authors are encouraged to submit reviews, minireviews, and commentaries. The journal ensures that submitted manuscripts undergo a rigorous and expedited review to publish scientifically and medically significant findings in a timely manner.