Clinical and Economic Outcomes Analyses of Women Developing Breast Cancer in a Managed Care Organization

OBJECTIVES: An evaluation was performed linking an administrative database to clinical information to determine the clinical and economic outcomes of women presenting with breast cancer in a managed care organization (MCO). METHODS: Administrative claims records were linked to clinical information obtained from hospital and tumor registry data for women diagnosed with adenocarcinoma or carcinoma in situ of the breast between 1990 and 1997. RESULTS: Only 3 of 53 mammogram-diagnosed women had developed recurrences compared with 12 of 69 self-diagnosed women. Self-diagnosed women with commercial insurance incurred more treatment-related cost, 30,557 dollars, compared with mammogram-diagnosed women, 13,913 dollars (P = 0.005). CONCLUSION: Women with commercial insurance had better clinical outcome at less cost when diagnosed by mammography as compared with women who detected the breast cancer by breast self-examination.