This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (104)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Development of a Basic Benefit Package

Herman Kattlove, MD, MPH; Alessandro Liberati, MD; Emmett Keeler, PhD; Robert H. Brook, MD, ScD

JAMA. 1995;273(2):142-148.

Abstract
Objective.
—To develop a basic benefit package for detection and treatment of early breast cancer by evaluating the effectiveness and costs for screening mammography, primary surgery, adjuvant therapy, and follow-up care.

Data Sources.
—Published articles were retrieved through MEDLINE; additional articles were obtained through searches of their bibliographies. Cancer statistics were taken from Surveillance, Epidemiology, and End Results (SEER) Program data, population statistics were taken from US Census data, and charges from 1993 Southern California Medicare fees were used to represent costs.

Study Selection.
—Studies were selected on the basis of their design. Preference, in decreasing order, was given to meta-analyses of randomized trials, individual randomized clinical trials, prospective cohort studies, retrospective cohort studies, and case series.

Data Extraction.
—Studies were examined for the effect of the intervention on overall survival, disease-free survival, and health-related quality of life. We evaluated effects on survival in terms of number of lives saved at 10 years and average years of life saved. Costs were related to the benefits observed and modeled onto a hypothetical health care organization of 500 000 lives.

Results.
—Based on this analysis, we recommend a basic benefit plan for the detection and treatment of early breast cancer that would include the following: (1) screening mammography only for women aged 50 to 69 years; (2) choice of mastectomy or breast-conserving surgery with radiation therapy for all women with early breast cancer; (3) adjuvant therapy for all women at risk of recurrence; and (4) only clinical follow-up without routine testing for metastatic disease.

Conclusions.
—By choosing which services they provide to specific groups of patients, providers can substantially reduce their expenses and still provide quality health benefits.

(JAMA. 1995;273:142-148)

Author Affiliations
From RAND, Santa Monica, Calif (Drs Kattlove, Liberati, Keeler, and Brook); the Department of Medicine (Drs Kattlove and Brook) and the Center for Health Sciences (Dr Brook), University of California, Los Angeles; and the Laboratory of Clinical Epidemiology, Istituto di Ricerche Farmacologiche "Mario Negri," Milan, Italy (Dr Liberati). Dr Kattlove is now with SalickNet Inc, Los Angeles, Calif.

Footnotes
Reprint requests to RAND Corporation, 1700 Main St, PO Box 2138, Santa Monica, CA 90407-2138 (Dr Brook).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Cost-Effectiveness Analysis of Mammography and Clinical Breast Examination Strategies: A Comparison with Current Guidelines
Ahern and Shen
Cancer Epidemiol. Biomarkers Prev. 2009;18:718-725.
ABSTRACT | FULL TEXT  

Cost-effectiveness of new guidelines for adjuvant systemic therapy for patients with primary breast cancer
Kievit et al.
Ann Oncol 2005;16:1874-1881.
ABSTRACT | FULL TEXT  

Bias in the Medical Journals: A Commentary
Kopans
Am. J. Roentgenol. 2005;185:176-182.
ABSTRACT | FULL TEXT  

On the efficacy of screening for breast cancer
Freedman et al.
Int J Epidemiol 2004;33:43-55.
ABSTRACT | FULL TEXT  

Regular Mammography Use Is Associated with Elimination of Age-Related Disparities in Size and Stage of Breast Cancer at Diagnosis
Randolph et al.
ANN INTERN MED 2002;137:783-790.
ABSTRACT | FULL TEXT  

Decision-Analytic Model and Cost-Effectiveness Evaluation of Postmastectomy Radiation Therapy in High-Risk Premenopausal Breast Cancer Patients
Lee et al.
JCO 2002;20:2713-2725.
ABSTRACT | FULL TEXT  

Cumulative Risk for Developing End-Stage Renal Disease in the US Population
Kiberd and Clase
J. Am. Soc. Nephrol. 2002;13:1635-1644.
ABSTRACT | FULL TEXT  

Cost Comparison of Mastectomy Versus Breast-Conserving Therapy for Early-Stage Breast Cancer
Barlow et al.
JNCI J Natl Cancer Inst 2001;93:447-455.
ABSTRACT | FULL TEXT  

Telomerase RNA as a Detection Marker in the Serum of Breast Cancer Patients
Chen et al.
Clin. Cancer Res. 2000;6:3823-3826.
ABSTRACT | FULL TEXT  

Improving Preventive Care by Prompting Physicians
Balas et al.
Arch Intern Med 2000;160:301-308.
ABSTRACT | FULL TEXT  

Cost-effectiveness of MR Imaging and Core-Needle Biopsy in the Preoperative Work-up of Suspicious Breast Lesions
Hrung et al.
Radiology 1999;213:39-49.
ABSTRACT | FULL TEXT  

Detecting Tumor-related Alterations in Plasma or Serum DNA of Patients Diagnosed with Breast Cancer
Chen et al.
Clin. Cancer Res. 1999;5:2297-2303.
ABSTRACT | FULL TEXT  

Using Practice Guideline Compendiums To Provide Better Preventive Care
Weingarten
ANN INTERN MED 1999;130:454-458.
FULL TEXT  

The Breast Cancer Screening Controversy and the National Institutes of Health Consensus Development Conference on Breast Cancer Screening for Women Ages 40–49
Kopans
Radiology 1999;210:4-9.
FULL TEXT  

Occlusion of the Internal Carotid Artery: Reopening a Closed Door?
Adams
JAMA 1998;280:1093-1094.
FULL TEXT  

Enhancing Mammography Use in the Inner City: A Randomized Trial of Intensive Case Management
Weber and Reilly
Arch Intern Med 1997;157:2345-2349.
ABSTRACT  

Assessing Quality of Care: Process Measures vs Outcomes Measures-Reply
McGlynn and Brook
JAMA 1996;276:1551-1552.
ABSTRACT  

Screening Mammography and Risk of Breast Cancer
Werneke
JAMA 1996;276:1470-1470.
ABSTRACT  

Likelihood Ratios for Modern Screening Mammography: Risk of Breast Cancer Based on Age and Mammographic Interpretation
Kerlikowske et al.
JAMA 1996;276:39-43.
ABSTRACT  

General Internal Medicine
Petersen and Daley
JAMA 1996;275:1811-1812.
ABSTRACT  

Screening to prevent renal failure in insulin dependent diabetic patients: an economic evaluation
Kiberd and Jindal
BMJ 1995;311:1595-1599.
ABSTRACT | FULL TEXT  

Utility of Follow-up Tests for Detecting Recurrent Disease in Patients With Malignant Melanomas
Weiss et al.
JAMA 1995;274:1703-1705.
ABSTRACT  

The Cost-effectiveness of Mammographic Screening Strategies
Lindfors and Rosenquist
JAMA 1995;274:881-884.
ABSTRACT  

The Efficacy of Mammography and Screening for Breast Cancer
Cotter
JAMA 1995;274:380-380.
ABSTRACT  

The Efficacy of Mammography and Screening for Breast Cancer
Corley
JAMA 1995;274:380-381.
ABSTRACT