Index
AAD. See American Academy of Dermatology (AAD)
ACPM. See American College of Preventive Medicine (ACPM)
Acquired immune deficiency syndrome/ human immunodeficiency virus (AIDS/HIV), 90, 96, 113, 250
See also Infectious agents
ACS. See American Cancer Society (ACS)
Actinic keratoses (AK), 190, 201
Actuarial Research Corporation, 338, 340
ADA. See American Dental Association (ADA)
Africa
Burkitt’s lymphoma in, 250
Age and aging
melanoma incidence/mortality and, 173–174
nonmelanoma skin cancer and, 176
population aged 65 and older, 228–231
preventive services for, U.S. Preventive Services Task Force recommendations, 130
preventive services for, U.S. Preventive Services Task Force recommendations/Medicare coverage comparison, 9, 128–131
teeth (natural), population 65 and older retaining, 228–231
transplant recipients aged 65 and older, statistics, 258
See also Population
Agency for Health Care Policy and Research (AHCPR), 6, 20, 95, 98, 131, 132, 135.
See also Evidence-Based Practice Centers (EPCs)
AHA. See American Heart Association (AHA)
AIDS/HIV. See Acquired immune deficiency syndrome/human immunodeficiency virus (AIDS/HIV)
AK. See Actinic keratoses (AK)
Alabama. See University of Alabama
Albuquerque, New Mexico basal cell cancer incidence, 176
Allograft. See Organ transplantation
American Academy of Dermatology (AAD), 38, 210
Melanoma/Skin Cancer Screening Programs, 203
skin cancer screening recommendations, 57
American Cancer Society (ACS), 38, 234
Department of Epidemiology and Surveillance Research, 233
skin cancer screening recommendations, 58, 178
American College of Physicians
Clinical Efficacy Assessment Program, 32
Common Diagnostic Tests: Use and Interpretation, 32
Common Screening Tests, 32
American College of Preventive Medicine (ACPM)
skin cancer screening recommendation, 58, 178
American Dental Association (ADA)
dental services, medically necessary, statement on, 89
American Heart Association (AHA), 83–84
Council on Scientific Affairs, 89
dental services, medically necessary, recommendations on, 89–90
American Joint Commission on Cancer Classification, 177
American Society of Transplant Physicians (ASTP). See American Society of Transplantation (AST)
American Society of Transplantation (AST)
Decade of Transplantation, 123
dental services, medically necessary, statement on, 90
immunosuppressive drugs for transplant patients, statement on, 123
Annals of Internal Medicine, 89
Antibodies
immunosuppression therapy for transplant patients, 290
See also Immunosuppressive drugs
Antiproliferative agents
transplant patients’ use of, 290–291
See also Immunosuppressive drugs
AST. See American Society of Transplantation (AST)
ASTP. See American Society of Transplantation (AST)
Australia
Geraldton, Western Australia, skin cancer incidence, 175–176
immunosuppression maintenance trials, 291
Queensland, skin cancer incidence, 173, 175
skin cancer incidence, 60–61, 174, 175–176
skin cancer screening, 3, 52, 60, 189–190, 201, 203, 204–205
skin cancer screening, public information campaigns, 207
Azathioprine, 290–291
AZT. See Zidovudine (AZT)
Balanced Budget Act of 1997, 1, 13–14, 15, 18, 65, 66, 67, 118, 127, 222, 329
Balanced Budget Act Refinements of 1999, 2, 100
Basal cell carcinoma. See Nonmelanoma skin cancers (NMSC)
Behavioral Risk Factor Surveillance System (BRFSS), 231
Bethesda, Maryland, 235
Bias
lead-time bias in skin cancer screening, 53
length bias in skin cancer screening and, 53
Blood poisoning. See Septicemia
Blue Cross and Blue Shield Association, 32
Technical Evaluation Center, 21
Bone cell death. See Osteoradionecrosis (ORN)
Bone marrow transplantation (BMT), 250, 254
oral complications of, leukemia patients, 252
oral mucositis from, leukemia patients, potentially effective treatments, 257
See also Organ transplantation
Breslow measurement technique
melanoma and, 177
BRFSS. See Behavioral Risk Factor Surveillance System (BRFSS)
British Columbia. See Canada
Burden of disease, 25
heart valve repair/replacement, 83–85, 94
immunosuppressive drugs for transplant patients, drug noncompliance, 124
transplantation, 80, 93–94, 104–108, 124
See also Diseases and disorders
Calcijex®, 296
Calcineurin phosphatase inhibitors
transplant patients’ use of, 292–293
See also Immunosuppressive drugs
California. See University of California at Los Angeles (UCLA)
CAN. See Chronic allograft nephropathy (CAN)
Canada
British Columbia, basal cell cancer incidence, 175
British Columbia, melanoma incidence, 191
cancer registries, 175
community-based screening programs, 137
immunosuppression maintenance trials, 291
renal transplantation analysis, 110
Toronto, osteoradionecrosis in hospital patients, 245
Canadian Task Force on the Periodic Health Examination (CTFPHE), 31, 33
Canady, Charles, 322
Cancer. See Head and neck cancer;
Leukemia;
Lymphoma;
Melanoma;
Nonmelanoma skin cancers (NMSC);
Skin cancer;
Skin cancer screening;
Tumor, node, metastasis (TNM) system
Cardiopulmonary resuscitation (CPR), 129, 130
Cardiovascular diseases and disorders. See Endocarditis;
Valvular heart disease
Carrier Advisory Committees, 21
Case-control studies
melanoma mortality, skin self-examination effects on, 206–207
CBO. See Congressional Budget Office (CBO)
CDC. See Centers for Disease Control and Prevention (CDC)
CE. See Cost-effectiveness (CE) analysis
Centers for Disease Control and Prevention (CDC), 90
Chapel Hill, North Carolina. See Research Triangle Institute/University of North Carolina at Chapel Hill (RTI-UNC)
dental pretreatment, septicemia reduction role for leukemia/lymphoma patients, 255–256
oral complications of, leukemia/lymphoma patients, 78, 251–252
oral mucositis from, leukemia/lymphoma patients, potentially effective treatments, 257
See also Medical tests and procedures
Chicago, Illinois. See University of Chicago Hospitals
Chronic allograft nephropathy (CAN), 299, 301
Committee on Medicare Coverage Extensions
analytic strategy of, 29–33
criteria and trade-offs, 27–29
dental services, medically necessary, Medicare coverage extension, assessment approach, 66–69
dental services, medically necessary, Medicare coverage extension, conclusions, 5–7, 96–98
dental services, medically necessary, Medicare coverage extension, cost estimates, 6, 85–88
dental services, medically necessary, Medicare coverage extension, findings, 91–95
dental services, medically necessary, research directions, 95–96
evidence/conclusions, linking of, 29, 32–33
health outcomes v. Medicare extension costs, considerations, 29, 35–37
immunosuppressive drugs for transplant patients, assessment approach, 102, 104
immunosuppressive drugs for transplant patients, benefits/harms, findings, 124
immunosuppressive drugs for transplant patients, drug noncompliance, findings, 124
immunosuppressive drugs for transplant patients, Medicare limit elimination, benefits/harms, findings, 125
immunosuppressive drugs for transplant patients, Medicare limit elimination, conclusions, 7–8, 126
immunosuppressive drugs for transplant patients, Medicare limit elimination, cost estimates, 8, 118–123
immunosuppressive drugs for transplant patients, Medicare limit elimination, noncompliance effects, findings, 124–125
immunosuppressive drugs for transplant patients, research directions, 125–126
immunosuppressive drugs for transplant patients, treatment effectiveness, findings, 124
intervention definition, 29, 30–31, 67
Medicare coverage extensions, costs estimation, xi, 29, 33–37, 329
objectives, 26–29
outcomes definition, 29, 30–31, 67–68
population definition, 29, 30–31, 67
principles for reaching conclusions, 25, 26–29
scientific literature identification/assessment, 29, 31–32
skin cancer screening, Medicare coverage extension, assessment approach, 25, 40–43
skin cancer screening, Medicare coverage extension, assessment criteria, 59–60
skin cancer screening, Medicare coverage extension, conclusions, 3–4, 62
skin cancer screening, Medicare coverage extension, cost estimates, 4, 25, 53–57
skin cancer screening, Medicare coverage extension, findings, 58–61
transplantation, burden of disease, findings, 124
See also Medicare
Conclusions and findings
dental services, medically necessary, Medicare coverage of, 5–7, 96–98
evidence link with, 27, 29, 32–33
guidelines definition, 33
immunosuppressive drugs for transplant patients, Medicare limit elimination, 7–8, 126
options definition, 33
skin cancer screening, Medicare coverage of, 3–4, 62
standards definition, 33
Congress, xii, 1, 2, 3, 6, 12, 26, 30, 34, 35, 39, 53, 55, 65, 66, 67, 86, 98, 100, 101, 102, 118, 123, 127–128, 130, 131, 132, 134, 135, 139, 310, 314, 320, 321, 322, 329, 349
Medicare decisionmaking role, 8–11, 18–19
See also Legislation;
Office of Technology Assessment (OTA);
Senate Finance Committee
Congressional Budget Office (CBO), 2, 34, 53, 55, 56, 86, 88, 118, 122, 319, 322, 330, 331, 338, 351
See also Congress
Connecticut
Tumor Registry, 206
See also New Haven, Connecticut
Consumer Price Index (CPI), 86, 87, 340
Contractors, private
Carrier Advisory Committees, 21
Medicare administrative contractors, decisionmaking role of, 8, 18, 21–22
Peer Review Organizations, 21
Corticosteroids
transplant patients’ use of, 292
See also Immunosuppressive drugs
Cost-effectiveness (CE) analysis, 29, 34, 36, 37, 129, 131–135, 209–210
Costs. See Health care costs
CPI. See Consumer Price Index (CPI)
CPR. See Cardiopulmonary resuscitation (CPR)
“Crowd out” definition of, 118
CTFPHE. See Canadian Task Force on the Periodic Health Examination (CTFPHE)
Cyclosporine A (CyA), 114, 262, 292–293, 301, 312–313
Cytomegalovirus (CMV). See Infectious agents
Dade County, Florida
skin examinations, survey of physicians, 55
DALYs. See Disability-adjusted life years (DALYs)
Databases. See MEDLINE
DCP. See Dental care program (DCP)
Deaths. See Mortality
Decayed, missing and filled tooth surfaces (DMFS), 240.
See also Oral health
Denmark
cancer registries, 175
Dental care program (DCP), 239–240.
See also Dental services, medically necessary;
Oral health
Dental services
chemotherapy pretreatment, septicemia reduction role for leukemia/lymphoma patients, 76, 78, 79, 92, 93, 97, 255–256
head/neck cancer patients and osteoradionecrosis, role of hyperbaric oxygen therapy, 75, 90, 244–245
head/neck cancer patients and osteoradionecrosis of jaws, treatment required, 72, 74, 75, 91, 97, 245–246
head/neck cancer patients, preservation influence on osteoradionecrosis incidence in, 241, 243–244, 248
head/neck cancer patients, pretreatment approaches, efficacy of, 239–240
head/neck cancer patients, pretreatment assessment, 237–238
head/neck cancer patients, preventive treatment needs, 238
Medicare current coverage, 5, 63–65, 68, 224–228, 230
oral mucositis from chemotherapy/bone marrow transplantation, potentially effective treatments, 257
See also Dental care program (DCP);
Oral health
Dental services, medically necessary analytic approach, 86, 96–97, 98, 233
benefits/harms of intervention, 25
burden of illness, 25
Committee on Medicare Coverage Extensions, objectives, 26–27
decision analytic framework for, 232–233
decision framework for, 231–232
head/neck cancer patients, benefits/ harms of, 92, 246–247
head/neck cancer patients in radiation, care for, 73
head/neck cancer patients, literature review, observations on, 235
head/neck cancer patients, Medicare coverage extension, 234, 247
head/neck cancer patients, Medicare coverage extension, cost estimates, 340
head/neck cancer patients, Medicare coverage extension, cost estimates, statistics, 341, 343
head/neck cancer patients, Medicare coverage extension, costs, methodology, 340
head/neck cancer patients, Medicare coverage extension, methods, 234–235
head/neck cancer patients, Medicare current coverage, 68, 230
head/neck cancer patients, outcome effects of, 74–75, 92, 246–247
head/neck cancer patients, treatment oral complications, 225, 234
heart repair/replacement patients, 269, 271
heart repair/replacement patients, benefits/harms, committee findings, 95
heart repair/replacement patients, care for, 84–85
heart repair/replacement patients, Medicare coverage extension, cost estimates, 345
heart repair/replacement patients, Medicare coverage extension, cost estimates, statistics, 348
heart repair/replacement patients, Medicare coverage extension, costs, methodology, 347
heart repair/replacement patients, Medicare current coverage, 68, 230
heart repair/replacement patients, outcome effects of, 85, 94–95
heart repair/replacement patients, treatment oral complications, 225
leukemia/lymphoma patients, Medicare coverage extension, cost estimates, 342
leukemia/lymphoma patients, Medicare coverage extension, cost estimates, statistics, 344
leukemia/lymphoma patients, Medicare coverage extension, costs, methodology, 342, 345
leukemia patients, benefits/harms of, committee findings, 92–93
leukemia patients, Medicare current coverage, 68, 230
leukemia patients, outcome effects of, 79–80, 92
leukemia patients, treatment oral complications, 226
lymphoma patients, benefits/harms of, committee findings, 93
lymphoma patients, care for, 78–79, 247, 250
lymphoma patients, Medicare current coverage, 68, 230
lymphoma patients, outcome effects of, 79–80, 93
lymphoma patients, treatment oral complications, 226
medical conditions considered for, 224, 226
Medicare coverage extension, xi, 4–5, 14, 268
Medicare coverage extension, and access to/use of, 22, 23
Medicare coverage extension, committee assessment approach, 66–69
Medicare coverage extension, committee conclusions, 5–7, 96–98
Medicare coverage extension, committee findings on, 91–95
Medicare coverage extension, cost estimates, 6, 25, 85–88, 336, 338, 340, 342, 345
Medicare coverage extension, cost estimates, statistics, 339, 341, 343, 344, 346, 348
Medicare coverage extension, costs, methodology, 340, 342, 345, 347
Medicare coverage extension, rationales, 22
Medicare coverage extension, research suggestions, 95–96
Medicare current coverage, 5, 63–65, 68, 224–228, 230
overview of, 222–233
statements of others on, 89–91
transplant patients, benefits/harms of, 94, 267
transplant patients, care after, 82, 265–266
transplant patients, care before, 82, 263–264
transplant patients, medically necessary services, 264
transplant patients, Medicare coverage extension, 85–88, 97–98, 257–259, 268
transplant patients, Medicare coverage extension, cost estimates, 85–88, 345
transplant patients, Medicare coverage extension, cost estimates, statistics, 346
transplant patients, Medicare coverage extension, costs, methodology, 345
transplant patients, Medicare current coverage, 68, 230, 266
transplant patients, oral infection and, 65, 78, 79, 80–81, 82, 94, 260–262
transplant patients, outcome effects of, 82–83, 94
transplant patients, review methods, 260
transplant patients, treatment of oral complications, 65, 66, 67, 69, 79, 225
See also Dental care program (DCP);
Dental services;
Oral health
Dentists and dentistry. See Dental care program (DCP);
Dental services;
Dental services, medically necessary;
Oral health
Department of Health and Human Services (DHHS), 1, 9, 12, 13–14, 19, 129, 131, 134, 222
“Put Prevention into Practice” initiative, 137
See also Health Care Financing Administration (HCFA)
DeWine, Mike, 322
DHHS. See Department of Health and Human Services (DHHS)
Diagnosis-related groups (DRGs), 270, 347;
see also Medicare
Dialysis, 100–101, 104, 110, 124, 126
costs to Medicare of, 116, 119, 121, 122, 296–297
mortality compared to transplant patients, 298
See also Medical tests and procedures
Digital rectal examination (DRE), 128
Disability-adjusted life years (DALYs), 36
Diseases and disorders
dental services, medically necessary, clinical conditions considered for, 224
See also Acquired immune deficiency syndrome/human immunodeficiency virus (AIDS/HIV);
Actinic keratoses
(AK);
Burden of disease;
Endocarditis;
End-stage renal disease (ESRD);
Epidemiology;
Head and neck cancer;
Infectious agents;
Leukemia;
Lymphoma;
Melanoma;
Nonmelanoma skin cancers (NMSC);
Osteoradionecrosis (ORN);
Septicemia;
Skin cancer;
Valvular heart disease
DMFS. See Decayed, missing and filled tooth surfaces (DMFS)
DRE. See Digital rectal examination (DRE)
DRGs. See Diagnosis-related groups (DRGs)
Drugs See Antibodies;
Antiproliferative agents;
Calcineurin phosphatase inhibitors;
Chemotherapy;
Corticosteroids;
Immunosuppressive drugs
ECRI. See Emergency Care Research Institute (ECRI)
Eggers, Paul, 122, 314, 319, 354, 356, 359, 360
Elwood, J.M., 204
Emergency Care Research Institute (ECRI), 21
Endocarditis, 83–85, 89–90, 94, 95, 97
dental-associated, proposed causal model, 84, 85, 95, 269
nonbacterial thrombotic endocarditis (NBTE), 269
See also Diseases and disorders
End-stage renal disease (ESRD), 8, 12, 13, 15, 17, 67, 80, 100, 101, 107, 112, 113, 119, 120, 121, 122, 123, 124, 126, 138, 287, 349, 352
dialysis costs for, 297–298
immunosuppressive therapy costs for, 297–298
medical expenditures for, statistics, 122
mortality among dialysis v. transplant patients, 298
therapy costs for, 296–298
transplantation and, Medicare coverage potential modifications, 100–101, 119, 121, 320–324
transplantation and, Medicare current policies’ impact on beneficiaries, 99–101, 102, 103, 111, 121, 122, 315, 317–318, 319, 320
transplantation and, Medicare 1972 policy, 310–311
transplantation and, Medicare 1978 policy, 311–312
transplantation and, Medicare 1984–1986 policy, 312–313
transplantation and, Medicare 1994 policy, 314–315
transplantation costs for, 296–298
See also Diseases and disorders
EORTC. See European Organization for Research and Treatment of Cancer (EORTC)
EPCs. See Evidence-Based Practice Centers (EPCs)
Epidemiology
melanoma, 173–175
nonmelanoma skin cancers, 175–176
skin cancer, 173–176
See also Burden of disease;
Diseases and disorders
Erythropoietin (rHuEPO), 296, 297
ESRD. See End-stage renal disease (ESRD)
Ethnicity
nonmelanoma skin cancer risk factors, 190
See also Population
Europe
immunosuppression therapy, 291, 292
skin cancer risk factors, 45
European Organization for Research and Treatment of Cancer (EORTC)
Quality of Life Questionnaire QLQ-C30, 246
Evidence-based assessment
Medicare coverage and, limits of, 2, 12, 138–139
Medicare decisionmaking and, 20, 132–133, 136
preventive services, Medicare coverage of, overview of, 9–10, 127–131, 136
Evidence-Based Medicine Working Group, 29
Evidence-Based Practice Centers (EPCs), 21, 40, 95
definition/duties of, 20
See also Agency for Health Care Policy and Research (AHCPR)
FDA. See Food and Drug Administration (FDA)
Federation of Special Care Organizations in Dentistry, 338
Finance Committee. See Senate Finance Committee
Findings
dental services, medically necessary, 91–95
head/neck cancer patients, dental care, benefits/harms, 92
head/neck cancer patients, dental care, burden of disease, 91
head/neck cancer patients, dental care, outcome effects, 91
heart valve repair/replacement patients, dental care, benefits/harms, 95
heart valve repair/replacement patients, dental care, burden of disease, 94
heart valve repair/replacement patients, dental care, outcome effects, 94–95
immunosuppressive drugs for transplant patients, benefits/harms, 124
immunosuppressive drugs for transplant patients, burden from noncompliance, 124
immunosuppressive drugs for transplant patients, Medicare limit elimination, 126
immunosuppressive drugs for transplant patients, Medicare limit elimination benefits/harms, 125
immunosuppressive drugs for transplant patients, Medicare limit elimination noncompliance effects, 124–125
immunosuppressive drugs for transplant patients, treatment effectiveness, 124
leukemia patients, dental care, benefits/harms, 92–93
leukemia patients, dental care, burden of disease, 92
leukemia patients, dental care, outcome effects, 92
lymphoma patients, dental care, benefits/harms, 93
lymphoma patients, dental care, burden of disease, 93
lymphoma patients, dental care, outcome effects, 93
skin cancer screening, Medicare coverage extension, 58–59
transplant patients, dental care, benefits/harms, 94
transplant patients, dental care, burden of disease, 93–94
transplant patients, dental care, outcome effects, 94
transplantation, burden of disease, 124
Florida, 322.
See also Dade County, Florida;
University of Miami
Food and Drug Administration (FDA), 20, 109, 290, 291, 293, 294, 295, 312–313
France
skin cancer early detection, benefits, 52
Friends of the NIDCR, 90.
See also National Institute of Dental and Craniofacial Research (NIDCR)
George Mason University, 117, 125–126
Germany
oral cancer patients, dental findings, 238
Graft, medical. See Organ transplantation
Great Britain. See United Kingdom
Guide to Clinical Preventive Services, Second Edition, 182, 191.
See also U.S. Preventive Services Task Force (USPSTF)
Hartke, Vance, 311
HBO. See Hyperbaric oxygen (HBO) therapy
HCFA. See Health Care Financing Administration (HCFA)
Head and neck cancer
burden of disease, 69–71, 91, 233–234
dental care for patients, benefits/harms, findings, 92
dental care for patients, findings, 91–92
dental care for patients, literature review, observations on, 235
dental care for patients, Medicare coverage extension, 5, 67, 234, 247
dental care for patients, Medicare coverage extension, conclusions, 97
dental care for patients, Medicare coverage extension, cost estimates, 86, 87, 340
dental care for patients, Medicare coverage extension, cost estimates, statistics, 341, 343
dental care for patients, Medicare coverage extension, costs, methodology, 340
dental care for patients, Medicare coverage extension, methods, 234–235
dental care for patients, Medicare current coverage, 68, 230
dental care for radiation therapy patients, 73
dental care for radiation therapy patients, Medicare cost savings, 342, 343
dental disease prevalence in, 73, 88, 91, 92, 238
dental preservation influence on osteoradionecrosis incidence in, 241, 243–244, 248
dental pretreatment approaches, efficacy of, 239–240
dental pretreatment assessment, 237–238
dental preventive treatment needs of, 238
oral complications associated with radiation, 72, 225, 234, 235–237
oral complications associated with radiation, quality of life impact, 246
osteoradionecrosis from postradiation extractions, role of hyperbaric oxygen therapy, 75, 90, 244–245
osteoradionecrosis incidence in, 241, 242
osteoradionecrosis of jaws, treatment required, 73–74, 90, 245–246
outcome, dental care effectiveness for, 74–75, 92
See also Diseases and disorders
Health. See Burden of disease;
Diseases and disorders;
Health care;
Health care costs;
Health care policy;
Health insurance;
Health maintenance organizations (HMOs);
Health outcomes;
Medical tests and procedures;
Oral health;
Preventive health care
Health and Human Services Department. See Department of Health and Human Services (DHHS)
Health care
access to, Medicare coverage and, 22–24
clinical trial patients, routine care coverage under Medicare, 14
insurance and use of, 23–24
See also Dental services;
Dental services, medically necessary;
Health care costs;
Health care policy;
Health insurance;
Health outcomes;
Medical tests and procedures;
Organ transplantation;
Oral health;
Preventive health care;
Surgery
Health care costs
Committee on Medicare Coverage Extensions, estimation of, 27, 29, 33–37, 329
Committee on Medicare Coverage Extensions, health outcomes v. costs, considerations, 29, 35–37
dental services, medically necessary, Medicare coverage extension, 6, 85–88, 336, 338, 340, 342, 345
dental services, medically necessary, Medicare coverage extension, methodology, 85–88, 340, 342, 345, 347
dental services, medically necessary, Medicare coverage extension, statistics, 85–88, 339, 341, 343, 344, 346, 348
dialysis, costs of, 296–297
end-stage renal disease, expenditures, statistics, 122
end-stage renal disease therapy, costs of, 296–298
head/neck cancer patients, dental care for, Medicare coverage extension, 85–88, 340
head/neck cancer patients, dental care for, Medicare coverage extension, methodology, 85–88, 340
head/neck cancer patients, dental care for, Medicare coverage extension, statistics, 85–88, 341, 343
heart repair/replacement, dental care for, Medicare coverage extension, 85–88, 345
heart repair/replacement, dental care for, Medicare coverage extension, methodology, 85–88, 347
heart repair/replacement, dental care for, Medicare coverage extension, statistics, 85–88, 348
immunosuppressive drugs, cost of, 113, 118–123, 295, 297–298
immunosuppressive drugs, Medicare/alternative funding, expiration of, 113–114
immunosuppressive drugs for transplant patients, Medicare limit elimination, estimates, 8, 118–123, 347, 349–362
immunosuppressive drugs for transplant patients, Medicare limit elimination, methodology, 354, 356, 359–360
immunosuppressive drugs for transplant patients, Medicare limit elimination,
statistics, 119, 121, 122–123, 350, 353, 355, 358, 362
insurance and use of health care services, 23–24
leukemia/lymphoma patients, dental care for, Medicare coverage extension, 2
leukemia/lymphoma patients, dental care for, Medicare coverage extension, statistics, 85–88, 344
leukemia/lymphoma patients, dental care for, Medicare coverage extension, methodology, 85–88, 342, 345
Medicare coverage extensions, cost/cost-effectiveness analysis role, 134–136, 139
Medicare coverage extensions, cost estimates, xi, 25, 53–57, 85–88, 118–123, 329–330
Medicare expenditure trends, 17–18
melanoma, screening for, cost-effectiveness studies, results, 207, 208
renal graft loss, Medicare costs of, statistics, 357, 361
skin cancer screening, Medicare coverage extension, 4, 53–57, 330–336, 337
skin cancer screening, Medicare coverage extension, methodology, 53–57, 331, 333, 336
skin cancer screening, Medicare coverage extension, statistics, 53–57, 332, 334, 335, 337
transplantation, costs of, 118–123, 296–298
transplantation, dental care for, Medicare coverage extension, 85–88, 345
transplantation, dental care for, Medicare coverage extension, methodology, 85–88, 345
transplantation, dental care for, Medicare coverage extension, statistics, 346
transplantation, Medicare current policies impact on beneficiaries, 315, 317–318, 319, 320
See also Health care;
Health care policy;
Health insurance;
Oral health;
Preventive health care
Health Care Financing Administration (HCFA), 5, 6, 17, 34, 35, 63, 67, 73, 75, 82, 88, 97, 98, 118, 131, 132, 134, 135, 314, 356
Coverage Issues Manual, 64
Division of Beneficiaries Research, 120, 354, 359
Medicare decisionmaking role of, 8, 10, 11, 18, 19–21, 22
Medicare Provider Analysis and Review (MEDPAR), 270
Office of the Actuary, 55, 120, 330, 333, 338
Technology Advisory Committee, 64
See also Department of Health and Human Services (DHHS);
Medicare Coverage Advisory Committee
Health care policy
congressional decisions for Medicare, 18–19, 127–128, 130, 131, 134, 135, 139
Health Care Financing Administration, decisions for Medicare, 18, 19–21, 131, 132–133, 134, 135
immunosuppressive drugs for transplant patients, Medicare current coverage, 103, 138, 139
Medicare transplantation current policies, impact on beneficiaries, 138, 315, 317–318, 319, 320
Medicare transplantation 1972 policy, 310–311
Medicare transplantation 1978 policy, 311–312
Medicare transplantation 1984–1986 policy, 312–313
Medicare transplantation 1994 policy, 314–315, 317–318
private contractors administering claims for Medicare, 18, 21–22
See also Health care;
Health care costs;
Health insurance;
Oral health;
Preventive health care
Health Care Policy and Research Agency. See Agency for Health Care Policy and Research (AHCPR)
Health insurance
health care services use and, 23–24
“Medigap” policy, 17
See also Health care;
Health care costs;
Medicaid;
Medicare
Health maintenance organizations (HMOs), 17, 21, 52–53, 137, 138, 319
Health outcomes
dental services, medically necessary, committee assessment, 67–68
head/neck cancer patients, dental care effects on, 74–75, 92
heart valve repair/replacement, dental care effects on, 84–85, 94–95
leukemia patients, dental care effects on, 79–80, 92
lymphoma patients, dental care effects on, 79–80, 93
Medicare coverage and, 27, 29, 30–31
Medicare coverage and, cost considerations, 35–37
Medicare coverage and health care access/use, impact on, 22–24
Medicare coverage and, limits of, 2, 12, 136–138
melanoma morbidity/mortality, treatment effectiveness, 205–209
nonmelanoma morbidity/mortality, treatment effectiveness, 205
skin cancer morbidity/mortality, early treatment effectiveness for, 205–209, 211
skin cancer morbidity/mortality, screening effects on, 202–203, 210
skin cancer screening and, effectiveness, 60, 179, 180, 181
transplant patients, dental care effects on, 82–83, 94
transplant patients, immunosuppressive drugs for, effectiveness, 124
transplant patients, immunosuppressive drugs for, Medicare coverage effects on, 114–118, 125
Health-related quality of life (HRQL), 246
Heart disease. See Endocarditis;
Valvular heart disease
Heart valve repair/replacement. See Surgery;
Valvular heart disease
Herpes simplex virus (HSV). See Infectious agents
HIV. See Acquired immune deficiency syndrome/human immunodeficiency virus (AIDS/HIV)
HLA. See Human lymphocyte antigen (HLA)
HMOs. See Health maintenance organizations (HMOs)
Hodgkin’s disease. See Lymphoma
Hospitals and hospitalization
heart repair/replacement patients, Medicare discharges, 271
heart repair/replacement patients, Medicare inpatient days, 270, 272
HRQL. See Health-related quality of life (HRQL)
Human immunodeficiency virus (HIV). See Acquired immune deficiency syndrome/human immunodeficiency virus (AIDS/HIV)
Human lymphocyte antigen (HLA), 289, 299
Hyperbaric oxygen (HBO) therapy, 75, 90, 342
osteoradionecrosis from postradiation extractions in head/neck cancer patients, role of, 244–245
osteoradionecrosis of jaws in head/neck cancer patients, treatment required, 245–246
Immunology
transplantation and, overview, 289–290
See also Diseases and disorders;
Immunosuppressive drugs
Immunosuppression
adequate for transplant patients, provision of, 300–301
excessive for transplant patients, avoiding, 302
transplantation and, acute rejection, 106, 107
transplantation and, chronic rejection, 106, 107
transplantation and, need for, 105–106
transplantation and, oral complications, 262
See also Diseases and disorders;
Immunology
Immunosuppressive drugs
Committee on Medicare Coverage Extensions, objectives, 27
costs of, 113
prednisone, 297
transplant patients and, benefits/harms, findings, 124
transplant patients and, costs of, 295, 297–298
transplant patients and, current uses/ future trends, 295–296
transplant patients and, drug compliance/noncompliance, issues, 111–113
transplant patients and, drug noncompliance, findings, 124
transplant patients and, Medicare/alternative funding, expiration of, 113–114
transplant patients and, Medicare coverage evolution, 100–102, 103, 287
transplant patients and, Medicare coverage benefits/harms, 104, 125
transplant patients and, Medicare coverage effects on health outcome, 114–118, 125
transplant patients and, Medicare coverage effects on noncompliance, findings, 124–125
transplant patients and, Medicare coverage potential modifications, 320–324
transplant patients and, Medicare current coverage policy, 103
transplant patients and, Medicare current policies impact on beneficiaries, 315, 317–318, 319, 320
transplant patients and, Medicare 1972 policy, 310–311
transplant patients and, Medicare 1978 policy, 311–312
transplant patients and, Medicare 1984–1986 policy, 312–313
transplant patients and, Medicare 1994 policy, 314–315, 317–318
transplant patients and, Medicare limit elimination, xi, 14
transplant patients and, Medicare limit elimination, access to/use of, 22, 23
transplant patients and, Medicare limit elimination, assessment approach, 102, 104
transplant patients and, Medicare limit elimination, conclusions, 126
transplant patients and, Medicare limit elimination, cost estimates, 25, 118–123, 347, 349–362
transplant patients and, Medicare limit elimination, cost estimates, statistics, 350, 353, 355, 358, 362
transplant patients and, Medicare limit elimination, costs, methodology, 354, 356, 359–360
transplant patients and, Medicare limit elimination, coverage rationales, 22–23
transplant patients and, Medicare limit elimination, Medicaid cost savings, 351–352
transplant patients and, Medicare limit elimination, statements on, 123
transplant patients and, overview, 99–100
transplant patients and, pharmacology of, 289–293, 294, 295
transplant patients and, research directions, 125–126
transplant patients and, therapy (adequate), barriers to, 111–118
transplant patients and, treatment benefits/harms, 25, 104, 109–110
transplant patients and, treatment effectiveness, findings, 124
See also Antibodies;
Antiproliferative agents;
Calcineurin phosphatase inhibitors;
Corticosteroids;
Immunology;
Immunosuppression
Immunosuppressive Drug Coverage Act of 1999, 322
Infectious agents
cytomegalovirus (CMV), 81, 291
leukemia/lymphoma and, 250, 253, 254, 255
septicemia oral sources for leukemia/ lymphoma patients, 252–255
transplantation and, 260–262
valvular heart disease and, 268
See also Acquired immune deficiency syndrome/human immunodeficiency virus (AIDS/HIV);
Diseases and disorders;
Septicemia
Infectious Diseases Society of America, 89
Infrastructure
Medicare coverage decisionmaking, 10–11, 131–136
Medicare coverage decisionmaking, cost/cost-effectiveness analysis role, 134–136
Medicare coverage decisionmaking, evidence-based recommendations, 136
Medicare coverage decisionmaking, technology assessment commitment, 132–133
Medicare coverage decisionmaking, weaknesses, examples, 133–134
Institute of Medicine (IOM), 2, 24, 30, 40, 51, 55, 91, 125, 172, 314, 321, 322, 329
Extending Medicare Reimbursement in Clinical Trials, 14
immunosuppressive drugs for transplant patients, statement on, 123
Kidney Failure and the Federal Government, 123
Role of Nutrition Therapy in Maintaining the Health of the Nation’s Elderly: Evaluating Coverage of Nutrition Services for Medicare Beneficiaries, 14
See also National Academy of Sciences (NAS)
Intra-Agency Agreement, 95
In vivo epiluminescence microscopy, 47
IOM. See Institute of Medicine (IOM)
Japan
skin cancer screening, 193
Joint Commission on Cancer Classification. See American Joint Commission on Cancer Classification
Journal of the American Medical Association, 29
Kidney failure. See End-stage renal disease (ESRD)
Larynx cancer. See Head and neck cancer
Lawrence Livermore National Laboratory, 192
Legislation
H.R. 3600, 65
See also Balanced Budget Act of 1997;
Balanced Budget Act Refinements of 1999;
Congress;
Immunosuppressive Drug Coverage Act of 1999;
National Organ Transplant Act of 1984;
Omnibus Budget Reconciliation Act of 1986 (OBRA 1986);
Omnibus Budget Reconciliation Act of 1987 (OBRA 1987);
Public Law 95–292;
Social Security Act of 1965 (SSA);
Social Security Amendments of 1972;
Transplant Amendments Act of 1990
Leukemia
bone marrow transplantation for, oral complications of, 252
burden of disease, 75–76, 92, 249
chemotherapy, dental pretreatment for, role in septicemia reduction, 255–256
chemotherapy, oral complications of, 251–252
dental care for patients, benefits/harms, findings, 92–93
dental care for patients, findings, 92–93
dental care for patients, Medicare coverage extension, 5, 67
dental care for patients, Medicare coverage extension, conclusions, 97
dental care for patients, Medicare coverage extension, cost estimates, 86, 87, 342
dental care for patients, Medicare coverage extension, cost estimates, statistics, 344
dental care for patients, Medicare coverage extension, costs, methodology, 342, 345
dental care for patients, Medicare current coverage, 68, 230
dental care for patients, overview, 78–79, 247, 248–249
dental care for patients, review methods, 247
incidence, 249
oral health problems associated with, 76, 249–250
oral health problems associated with treatment, 78, 225, 250, 251–252
oral mucositis from therapy, potentially effective treatments for, 257
outcomes, dental care effectiveness for, 79–80, 92
septicemia, oral sources for patients, 252–255
See also Diseases and disorders
Lewin Group, 53, 118, 323, 329
Los Angeles, California. See University of California at Los Angeles (UCLA)
Lymphoma
burden of disease, 76–77, 93, 250–251
chemotherapy, dental pretreatment for, role in septicemia reduction, 255–256
chemotherapy, oral complications of, 251–252
dental care for patients, benefits/harms, findings, 93
dental care for patients, findings, 93
dental care for patients, Medicare coverage extension, 5, 67
dental care for patients, Medicare coverage extension, conclusions, 97–98
dental care for patients, Medicare coverage extension, cost estimates, 86, 87, 342
dental care for patients, Medicare coverage extension, cost estimates, statistics, 344
dental care for patients, Medicare coverage extension, costs, methodology, 342, 345
dental care for patients, Medicare current coverage, 68, 230
dental care for patients, overview, 79, 250
Hodgkin’s disease, dental/oral considerations in, 253
incidence of, 250–251
non-Hodgkin’s lymphomas, dental/oral considerations in, 254
oral health problems associated with, 77, 251
oral health problems associated with treatment, 78, 225, 251–252
oral mucositis from therapy, potentially effective treatments for, 257
outcomes, dental care effectiveness in, 79–80, 93
septicemia oral sources for patients, 252–255
treatment for, 77
See also Diseases and disorders
Marden, Marcia Campbell, 317
Maryland. See Bethesda, Maryland;
University of Maryland
Mayo Clinic, 84
M.D.Anderson Hospital and Tumor Institute, 240, 241, 243, 253
Medicaid, 15, 17, 18, 35, 114, 118, 120, 122, 317–318, 319, 321
cost savings from Medicare coverage of immunosuppressive drugs for transplant patients, 351–352
See also Health insurance
Medical insurance. See Health insurance;
Medicaid;
Medicare
Medical tests and procedures
access to, Medicare coverage extension and, 22–24
clinical trial patients, Medicare coverage of routine care, 14
insurance and use of, 23–24
in vivo epiluminescence microscopy, 47
oral complications associated with treatment for selected conditions, 225
skin cancer diagnosis, accuracy of tests, 50, 180, 181
skin cancer diagnosis procedures, 47–48
skin cancer follow-up care/biopsies, rates of referral from screening, studies, 194–199, 201
skin cancer follow-up referral procedure, effects on screening yield, studies, 202–203
skin cancer treatment, availability of, 45–46
skin cancer treatment, early, effectiveness of, 205–207, 208–209, 213
skin self-care and knowledge, skin cancer screening effects on, 203, 204
See also Chemotherapy;
Dental services, medically necessary;
Dialysis;
Health care;
Organ transplantation;
Radiation therapy;
Skin cancer screening;
Surgery
Medicare
administrative contractors, coverage decisions of, 8, 18, 21–22
Carriers Manual, 227
congressional coverage decisions, 8, 18–19
cost/cost-effectiveness analysis, decisionmaking role of, 134–136, 139
Coverage Issues Manual, 227
decisionmaking, overview on, 8–11, 18–22, 131–136
dental services, current coverage, 5, 63–65, 68, 224–228, 230
dental services, medically necessary, coverage extension, xi, 4–5, 14, 22, 67, 222, 223
dental services, medically necessary, coverage extension, committee assessment approach, 55–69
dental services, medically necessary, coverage extension, committee conclusions, 5–7, 96–98
dental services, medically necessary, coverage extension, committee findings, 91–95
dental services, medically necessary, coverage extension, cost estimates, 6, 85–88, 336, 338, 340, 342, 345
dental services, medically necessary, coverage extension, cost estimates, statistics, 339, 341, 343, 344, 346, 348
dental services, medically necessary, coverage extension, costs, methodology, 340, 342, 345, 347
dialysis costs, 296–297
end-stage renal disease therapy, costs, 296–298
enrollment/expenditure trends, 17–18
evidence-based assessment, decision-making role of, 2, 9–10, 20, 127–131, 132–133, 136
extension of coverage, rationales for, 22–23
head/neck cancer patients, dental care coverage extension, 234
head/neck cancer patients, dental care coverage extension, cost estimates, 340
head/neck cancer patients, dental care coverage extension, cost estimates, statistics, 341, 343
head/neck cancer patients, dental care coverage extension, costs, methodology, 340
head/neck cancer patients, dental care current coverage, 68, 230
health care access, coverage extension and, 22–24
Health Care Financing Administration, decisionmaking role of, 8, 18, 19–21, 22
health outcomes, coverage extension and, 2, 22–24
heart valve repair/replacement patients, dental care, 269, 271
heart valve repair/replacement patients, dental care, coverage extension, cost estimates, 345, 347
heart valve repair/replacement patients, dental care, coverage extension, cost estimates, statistics, 348
heart valve repair/replacement patients, dental care, coverage extension, costs methodology, 347
heart valve repair/replacement patients, dental care, current coverage, 68, 230
heart valve repair/replacement patients, dental care, review methods, 270–271
heart valve repair/replacement patients, discharges, 271
heart valve repair/replacement patients, inpatient days for beneficiaries, 270, 272
heart valve repair/replacement patients,
utilization and reimbursement for, 270, 272
historical background, 15–17
immunosuppressive drugs for transplant patients, costs, 297–298
immunosuppressive drugs for transplant patients, coverage effect on noncompliance, findings, 124–125
immunosuppressive drugs for transplant patients, coverage evolution, 100–102, 103, 287
immunosuppressive drugs for transplant patients, current coverage policy, 7, 103
immunosuppressive drugs for transplant
patients, funding expiration, 113–114
immunosuppressive drugs for transplant
patients, time limit elimination, xi, 7, 14, 22, 322
immunosuppressive drugs for transplant patients, time limit elimination, benefits/harms, 104, 125
immunosuppressive drugs for transplant patients, time limit elimination, assessment approach, 102, 104
immunosuppressive drugs for transplant patients, time limit elimination, conclusions, 7–8, 126
immunosuppressive drugs for transplant patients, time limit elimination, cost estimates, 8, 118–123, 347, 349–362
immunosuppressive drugs for transplant patients, time limit elimination, cost estimates, statistics, 350, 353, 355, 358, 362
immunosuppressive drugs for transplant patients, time limit elimination, cost savings for Medicaid, 351–352
immunosuppressive drugs for transplant patients, time limit elimination, costs, methodology, 354, 356, 359–360
immunosuppressive drugs for transplant patients, time limit elimination, health outcome effects of, 114, 118, 124
immunosuppressive drugs for transplant patients, time limit elimination, statements on, 123
infrastructure for coverage, 10–11, 131–136
infrastructure for coverage, specific weaknesses, examples, 133–134
leukemia/lymphoma patients, dental care, coverage extension, cost estimates, 342
leukemia/lymphoma patients, dental care, coverage extension, cost estimates, statistics, 344
leukemia/lymphoma patients, dental care, coverage extension, costs, methodology, 342, 345
leukemia patients, dental care current coverage, 68, 230
lymphoma patients, dental care current coverage, 68, 230
Medicare Provider Analysis and Review (MEDPAR), 270
Part A, 15–16, 17, 21, 64, 226, 227, 330
Part B, 15, 16, 21, 34–35, 64, 86, 87, 88, 119, 122, 128, 226, 227, 234, 258, 266, 330, 331, 333, 336, 340, 345, 349
Part C, 15
Physician Fee Schedule, 55
preventive services coverage, evidence-based assessment, limits of, 2, 12, 138–139
preventive services coverage, evidence-based assessment role, 9–10, 127–131, 136
preventive services coverage, health outcome limits of, 2, 12, 136–138
preventive services coverage, overview, 8–11
preventive services current coverage and U.S. Preventive Services Task Force recommendations, comparison, 9, 128–131
preventive services current coverage, listing, 128
renal graft loss, cost to, statistics, 357, 361
skin cancer screening, coverage extension, xi, 2–3, 14, 22, 25
skin cancer screening, coverage extension, assessment approach, 40–43
skin cancer screening, coverage extension, assessment criteria, 59–60
skin cancer screening, coverage extension, conclusions, 3–4, 62
skin cancer screening, coverage extension, cost estimates, 4, 53–57, 330–336, 337
skin cancer screening, coverage extension, cost estimates, statistics, 332, 334, 335, 337
skin cancer screening, coverage extension, costs, methodology, 331, 333, 336
skin cancer screening, coverage extension, findings, 58–61
skin cancer screening, coverage extension, overview, 38–40
skin cancer screening, coverage extension, pathway, 49
skin cancer screening, current coverage, 3
technology assessment commitment, decisionmaking role of, 20, 132–133
transplantation, costs, 296–298
transplantation, coverage of, 287
transplantation, current policies’ impact on beneficiaries, 315, 317–318, 319, 320
transplantation, dental care for, coverage extension, 257–259
transplantation, dental care for, coverage extension, cost estimates, 345
transplantation, dental care for, coverage extension, cost estimates, statistics, 346
transplantation, dental care for, coverage extension, costs, methodology, 345
transplantation, dental care for, current coverage, 68, 230
transplantation, dental care for, review methods, 260
transplantation, 1972 policy, 310–311
transplantation, 1978 policy, 311–312
transplantation, 1984–1986 policy, 312–313
transplantation, 1994 policy, 314–315, 318–320
transplantation, potential modifications to program, 320–324
See also Committee on Medicare Coverage Extensions;
Diagnosis-related groups (DRGs);
Health insurance;
Medicare Coverage Advisory Committee;
Medicare Secondary Payer (MSP)
Medicare Coverage Advisory Committee, 20, 131
objectives, 26–27
principles, 27
See also Health Care Financing Administration (HCFA);
Medicare
Medicare Coverage Extensions Committee. See Committee on Medicare Coverage Extensions
Medicare Secondary Payer (MSP), 349, 351.
See also Medicare
MEDLINE, 182, 234, 247, 260, 270
Melanoma
ABCDE checklist for, 47, 49, 176
Breslow measurement technique, 177
burden of disease, 43–44, 173–176
diagnosis, 44, 47–48, 52, 53, 60, 176–177
diagnosis delay, consequences of, retrospective studies, 208–209
epidemiology, 173–176
incidence/mortality, age and, 42, 43–44, 173, 174
malignant lesions found in screening, data on, 200
mortality and stages found in screening v. usual practice, studies results, 207, 208
mortality, skin self-examination effects, case-control study, 206–207
natural history, 176–177
risk factors, 40–41, 43, 44–45, 49–50, 62, 191–192
screening for, cost-effectiveness studies, results, 42, 56, 61, 209–210
screening tests, 48–50, 60, 182, 184–193
staging, 177
treatment, availability of, 45–46
treatment, early, effectiveness of, studies results, 39, 50–51, 60, 62, 205–209, 213
warning symptoms, 38
See also Diseases and disorders;
Nonmelanoma skin cancers (NMSC);
Skin cancer;
Skin cancer screening
Methods and methodology
cost estimation, 27, 29, 33–37
dental services, medically necessary,
analytic approach, 233
dental services, medically necessary, decision analytic framework, 232–233
dental services, medically necessary, decision framework, 231–232
dental services, medically necessary, Medicare coverage extension, assessment approach, 66–69
dental services, medically necessary, Medicare coverage extension for, costs, 340, 342, 345, 347
head/neck cancer patients, dental care for, 234–235
head/neck cancer patients, dental care for, Medicare coverage extension, costs, 340
heart valve repair/replacement patients, dental care for, Medicare coverage extension to, costs, 347
heart valve repair/replacement patients, dental care for, review methods, 270–271
immunosuppressive drugs for transplant patients, Medicare limit elimination, assessment, 102, 104
immunosuppressive drugs for transplant patients, Medicare limit elimination, costs, 354, 356, 359–360
leukemia/lymphoma, dental care for, 247
leukemia/lymphoma, dental care for, Medicare coverage extension to, costs, 342, 345
medical intervention, evidence pyramid for assessing, 28, 29
skin cancer screening, data extraction/synthesis, 182–184
skin cancer screening, literature review, 182
skin cancer screening, Medicare coverage extension, assessment approach, 40–43
skin cancer screening, Medicare coverage extension, costs, 331, 333, 336
transplantation, dental care for, Medicare coverage extension to, costs, 345
transplantation, dental care for, review methods, 260
Miami, Florida. See University of Miami
Microorganisms. See Infectious agents
Minnesota. See Olmstead County, Minnesota;
Rochester, Minnesota
MMF. See Mycophenolate mofetil (MMF)
Models and modeling
dental services, medically necessary, 223
dental services, medically necessary, decision model, 231
endocarditis, dental-associated, proposed causal model, 269
immunosuppressive drugs for transplant patients, Medicare coverage extension, estimated costs, 119, 120, 121, 122–123
skin cancer screening, Medicare coverage extension, cost estimates, 55
Mortality
dialysis v. renal transplantation, comparison, 298
melanoma, age and, 173–176
melanoma, skin self-examination effects on, case-control study, 206–207
melanoma, stages found in screening v. usual practice, studies, 207, 208
skin cancer, 172
skin cancer early treatment, effectiveness of, 205–209
skin cancer, screening effects on, 39, 41, 42, 52, 53, 58, 59, 60, 204, 205, 212
See also Burden of disease;
Population
MSP. See Medicare Secondary Payer (MSP)
Mucositis. See Oral mucositis
Mycophenolate mofetil (MMF), 290–291
National Academy of Sciences (NAS), 1, 13–14, 24, 222.
See also Institute of Medicine (IOM)
National Alliance for Oral Health, 223
National Cancer Institute (NCI), 43, 44, 46, 90, 173, 233
PDQ information system, 57
skin cancer screening statement, 57–58
See also Surveillance, Epidemiology and End Results (SEER) program
National Committee for Quality Assurance (NCQA), 137
National Health and Nutrition Examination Survey (NHANES), 81, 228, 231, 263
National Health Examination Survey, 228
National Health Interview Survey, 230
National Institute of Dental and Craniofacial Research (NIDCR), 95
dental services, medically necessary, statement on, 90–91
Oral Health, Cancer Care and You: Fitting the Pieces Together, 90
See also Friends of the NIDCR;
National Institutes of Health (NIH)
National Institute of Dental Research, 228
National Institute of Nursing Research, 90
National Institutes of Health (NIH), 6, 11, 98, 132, 133, 301
Consensus Development Conference on Oral Complications of Cancer Therapies: Diagnosis, Prevention, and Treatment, 1989, 90, 235
dental services, medically necessary, statement on, 90
skin cancer screening statements, 57–58
See also National Institute of Dental and Craniofacial Research (NIDCR)
National Kidney Foundation (NKF), 117, 125–126
immunosuppressive drugs for transplant patients, statement on, 123
National Medical Expenditure Survey, 1987, 88, 340
National Oral Health Information Clearinghouse, 90
National Organization for Rare Diseases (NORD), 115, 116
National Organ Transplant Act of 1984, 313, 321
National Task Force on Organ Transplantation, 313
NBTE. See Endocarditis
NCI. See National Cancer Institute (NCI)
NCQA. See National Committee for Quality Assurance (NCQA)
Neck cancer. See Head and neck cancer
Netherlands
skin cancer screening study, 185, 188
New England Journal of Medicine
“Clinical Problem Solving,” 29
New Hampshire
nonmelanoma skin cancer incidence, 176
New Haven, Connecticut
skin examinations, survey of physicians, 55
New Mexico. See Albuquerque, New Mexico
New Zealand
skin cancer trends, 174
NHANES. See National Health and Nutrition Examination Survey (NHANES)
NIDCR. See National Institute of Dental and Craniofacial Research (NIDCR)
NIH. See National Institutes of Health (NIH)
Nixon, Richard M., 311
NKF. See National Kidney Foundation (NKF)
NMSC. See Nonmelanoma skin cancers (NMSC)
Nonbacterial thrombotic endocarditis (NBTE). See Endocarditis
Non-Hodgkin’s lymphoma. See Lymphoma
Nonmelanoma skin cancers (NMSC) (basal cell and squamous cell)
burden of disease, 44–45, 175–176
diagnosis, 177–178
epidemiology, 175–176
natural history, 177–178
Psorolen plus ultraviolet-A radiation and, 178
risk factors, 190
staging, 177–178
treatment, availability of, 46
treatment, early, effectiveness of, studies results, 205, 213
warning symptoms, 38
See also Diseases and disorders;
Melanoma;
Skin cancer;
Skin cancer screening
NORD. See National Organization for Rare Diseases (NORD)
North Carolina. See Research Triangle Institute/University of North Carolina at Chapel Hill (RTI-UNC)
OBRA 1986. See Omnibus Budget Reconciliation Act of 1986 (OBRA 1986)
OBRA 1987. See Omnibus Budget Reconciliation Act of 1987 (OBRA 1987)
Office of Technology Assessment (OTA), 9, 19, 132, 134, 314, 322, 323
immunosuppressive drugs for transplant patients, statement on, 123
Outpatient Immunosuppressive Drugs Under Medicare, 123
See also Congress
Ohio, 322
Olmstead County, Minnesota, 84
Omnibus Budget Reconciliation Act of 1986 (OBRA 1986), 313, 321
Omnibus Budget Reconciliation Act of 1987 (OBRA 1987), 314
OPTN. See Organ Procurement and Transplantation Network (OPTN)
Oral cavity cancer. See Head and neck cancer
Oral health
bone marrow transplantation for leukemia patients, complications of, 252
chemotherapy for leukemia/lymphoma patients, complications of, 251–252
endocarditis, dental-associated, proposed causal model, 269
head/neck cancer patients, dental disease prevalence in, 238
head/neck cancer patients, radiation complications, 72, 225, 235–237
head/neck cancer patients, radiation complications, quality-of-life impact, 246
heart valve repair/replacement, related problems, 84, 225
Hodgkin’s disease, considerations in, 251, 252, 253
immunosuppression therapy for transplant patients, complications, 262
infections and organ transplantation, 260–262
lesions and transplantation, 266
leukemia, related problems, 76, 249–250
leukemia treatment, related problems, 78, 225, 250, 251–252
lymphoma, related problems, 77, 251
lymphoma treatment, related problems, 78, 225, 251–252
non-Hodgkin’s lymphoma, considerations in, 254
population age 65 and older retaining natural teeth, 228–231
septicemia sources in leukemia/lymphoma patients, 252–255
transplantation, considerations after, 265–266
transplantation, considerations before, 263–264
transplantation, infections and, 260–262
transplantation, lesions in, 266
transplantation, related problems, 80–81, 225, 260–262
See also Decayed, missing and filled tooth surfaces (DMFS);
Dental care program (DCP);
Dental services;
Dental services, medically necessary;
Diseases and disorders;
Health care;
Health care policy;
Oral mucositis;
Osteoradionecrosis (ORN)
Oral mucositis
chemotherapy/bone marrow transplantation and, potentially effective treatments for, 257
See also Oral health
Oregon
health care reform initiative, 139
Oregon Health Sciences University
Evidence-Based Practice Center, 40
Organ Procurement and Transplantation Network (OPTN), 313
Organ transplantation
age 65 and older, recipients of, statistics, 258
antibodies, immunosuppressive use of, 290
antiproliferative agents, immunosuppressive use of, 290–291
azathioprine, immunosuppressive use of, 290–291
burden of disease, 80, 93–94, 104–108, 124
calcineurin phosphatase inhibitors, immunosuppressive use of, 292, 293
corticosteroids, immunosuppressive use of, 292
costs of, 296–298
cyclosporine, immunosuppressive use of, 292, 293
dental care and, after surgery, 82, 265–266, 267
dental care and, before surgery, 82, 263–264, 267
dental care and, benefits/harms, 94, 267
dental care and, committee findings, 93–94
dental care and, Medicare coverage extension, 5, 67, 257–259, 268
dental care and, Medicare coverage extension, committee conclusions, 97–98
dental care and, Medicare coverage extension, cost estimates, 85–88, 345
dental care and, Medicare coverage extension, cost estimates, statistics, 346
dental care and, Medicare coverage extension, costs, methodology, 345
dental care and, Medicare current coverage of, 68, 230, 266
dental care and, review methods, 260
dental care considered medically necessary, 264
heart/liver/lung, immunosuppressive drugs for, Medicare coverage extension, costs, 360, 362
immunology and, overview, 289–290
immunosuppression, adequate, provision of, 300–301
immunosuppression, excessive, avoiding, 302
immunosuppression, need for, 105–107
immunosuppression therapy and, oral complications, 262, 267
immunosuppressive drugs currently available, cost of, 294
immunosuppressive drugs for, adequate therapy, barriers to, 111–118
immunosuppressive drugs for, benefits/harms, findings, 124
immunosuppressive drugs for, burden from patient noncompliance, findings, 124
immunosuppressive drugs for, burden of disease, 25
immunosuppressive drugs for, committee assessment approach, 102, 104
immunosuppressive drugs for, compliance/noncompliance, issues, 111–113
immunosuppressive drugs for, costs of, 296–298
immunosuppressive drugs for, current uses/future trends, 294–296
immunosuppressive drugs for, intervention, 25
immunosuppressive drugs for, Medicare/alternative funding, expiration of, 113–114
immunosuppressive drugs for, Medicare coverage benefits/harms, 104, 125
immunosuppressive drugs for, Medicare coverage evolution, 100–102, 103, 287, 310–315
immunosuppressive drugs for, Medicare coverage extension, xi, 14
immunosuppressive drugs for, Medicare coverage extension, conclusions, 126
immunosuppressive drugs for, Medicare coverage extension, cost estimates, 25, 118–123, 347, 349–362
immunosuppressive drugs for, Medicare coverage extension, cost estimates, statistics, 350, 353, 355, 358, 362
immunosuppressive drugs for, Medicare coverage extension, costs, methodology, 354, 356, 359–360
immunosuppressive drugs for, Medicare coverage extension, Medicaid cost savings, 351–352
immunosuppressive drugs for, Medicare coverage extension, rationales for, 22, 23
immunosuppressive drugs for, Medicare coverage extension, statements on, 123
immunosuppressive drugs for, Medicare coverage, health outcomes effects of, 114–118, 124
immunosuppressive drugs for, Medicare coverage, noncompliance effects of, 124–125
immunosuppressive drugs for, Medicare current coverage policy, 103
immunosuppressive drugs for, noncompliance of patients, findings, 124, 299, 319, 320, 321, 323
immunosuppressive drugs for, overview, 99–100
immunosuppressive drugs for, pharmacology of, 289–295
immunosuppressive drugs for, research directions, 125–126
immunosuppressive drugs for, treatment benefits/harms, 25, 104, 109–110
immunosuppressive drugs for, treatment effectiveness, findings, 124
Medicare coverage for, introduction, 100–101, 122, 287
Medicare coverage, potential modifications to, 320–324
Medicare current policies’ impact on beneficiaries, 315, 317–318, 319, 320
Medicare 1972 policy for, 310–311
Medicare 1978 policy for, 311–312
Medicare 1984–1986 policy for, 312–313
Medicare 1994 policy for, 314–315, 317–318
mortality compared with dialysis patients, 298
Mycophenolate mofetil (MMF), immunosuppressive use of, 290–291
oral health problems associated with, 80–81, 225
oral infections in, 260–262, 267
oral lesions in, 266
outcomes, dental care effectiveness for, 82–83, 94
outcomes, expected, beyond 3 years, 287–289
protein-based therapy, immunosuppressive use, 290
rejection, late, in nonrenal transplants, causes, 300
rejection, late, in renal transplants, causes, 298–300
renal graft loss, Medicare costs of, statistics, 357, 361
renal, immunosuppressive drugs for, Medicare coverage extension, cost estimates, 352, 353, 354, 355, 356, 358, 359–360
statistics, by organ type, 105, 259
survival, long-term, barriers to, 300
survival, long-term, impacts of, 317–318
survival, long-term, scientific basis, 287–296
survival rates, statistics by organ type, 109
tacrolimus, immunosuppressive use of, 293
treatment, effective, availability, 109–110
waiting list for, statistics by organ type, 108, 259
waiting lists for, 107
See also Bone marrow transplantation (BMT);
Medical tests and procedures;
Surgery
Organ Transplantation National Task Force. See National Task Force on Organ Transplantation
Osteoradionecrosis (ORN), 72, 73, 74, 75, 90, 91, 92, 97, 342
head/neck cancer patients and ORN of jaws, treatment required, 245–246
head/neck cancer patients and postradiation extractions, role of hyperbaric oxygen therapy, 244–245
head/neck cancer patients, dental preservation impact on incidence of, 241, 243–244, 248
head/neck cancer patients, incidence of, 242
head/neck cancer patients in radiation therapy, complications from, 236–237
head/neck cancer patients in radiation therapy, cost savings from preventive care, statistics, 343
See also Oral health
OTA. See Office of Technology Assessment (OTA)
Peer Review Organizations (PROs), 21
Pennsylvania. See University of Pennsylvania Hospital
Pharmacology
immunosuppressants, 289–295
Pharynx cancer. See Head and neck cancer
P.L. 92–603. See Social Security Amendments of 1972
P.L. 95–292. See Public Law 95–292
P.L. 98–507. See National Organ Transplant Act of 1984
P.L. 99–509. See Omnibus Budget Reconciliation Act of 1986 (OBRA 1986)
P.L. 105–33. See Balanced Budget Act of 1997
P.L. 106–113. See Balanced Budget Act Refinements of 1999
Population
definition of, assessment approach, 29, 30–31
dental services, medically necessary, definition of, 67
skin cancer screening, definition of, 41
See also Age and aging;
Ethnicity;
Mortality
Population burden of disease. See Burden of disease
Preventive health care
Medicare coverage, health outcome limits of, 2, 12, 136–138
Medicare coverage, evidence-based assessment and, 9–10, 127–131, 136
Medicare coverage, evidence limits for, 2, 12, 138–139
Medicare current coverage, and U.S. Preventive Services Task Force recommendations, comparison, 128–131
Medicare current coverage of, listing, 128
U.S. Preventive Services Task Force recommendations for, listing, 130
See also Health care;
Health care policy
Preventive Services Task Force. See U.S. Preventive Services Task Force (USPSTF)
Princess Margaret Hospital, 245
Private industry. See Contractors, private
PROs. See Peer Review Organizations (PROs)
Prostate specific antigen (PSA), 128
Proteins. See Antibodies
PSA. See Prostate specific antigen (PSA)
Public Law 92–603. See Social Security Amendments of 1972
Public Law 95–292, 312
Public Law 98–507. See National Organ Transplant Act of 1984
Public Law 99–509. See Omnibus Budget Reconciliation Act of 1986 (OBRA 1986)
Public Law 105–33. See Balanced Budget Act of 1997
Public Law 106–113. See Balanced Budget Act Refinements of 1999
Quality-adjusted life years (QALYs), 36, 110, 125
Quality of life
head/neck cancer treatment, oral complications from, impact on, 246
Quality of Life Questionnaire QLQ-C30, 246
Race. See Ethnicity
RAD. See Sirolimus
Radiation therapy
head/neck cancer patients, pretreatment dental approaches, efficacy of, 239–240
head/neck cancer patients, pretreatment dental assessment, 237–238
head/neck cancer treatment, 71–72
head/neck cancer treatment, dental care for patients, 73
head/neck cancer treatment, dental care for patients, Medicare cost savings, 342, 343
head/neck cancer treatment, oral complications from, 72, 235–237
head/neck cancer treatment, oral complications from, quality of life impact, 246
lymphoma treatment, 77
lymphoma treatment, oral complications from, 78
See also Medical tests and procedures
Rapamycin (RAD). See Sirolimus
Recommendations. See Conclusions and findings
Relative value unit (RVU), 331
Rennie, D., 286
Research
dental services, medically necessary, 95–96
head/neck cancer patients, dental services for, literature review observations, 235
immunosuppressive drugs for transplant patients, 125–126
scientific literature identification/assessment by Committee on Medicare Coverage Extensions, 29, 31–32
skin cancer screening, 60–61, 182
Research Triangle Institute/University of North Carolina at Chapel Hill (RTI-UNC), 95
Evidence-Based Practice Center, 95
rHuEPO. See Erythropoietin (rHuEPO)
Risk assessment
melanoma risk factors, 190–191
nonmelanoma skin cancer risk factors, 190
skin cancer screening use of, accuracy of, 189, 190–193, 210–211
Rocaltrol®, 296
Rochester, Minnesota
basal cell cancer incidence, 176
RTI-UNC. See Research Triangle Institute/University of North Carolina at Chapel Hill (RTI-UNC)
RVU. See Relative Value Unit (RVU)
SangCyA®, 298
Scientific literature. See Research
Scotland. See United Kingdom
SEER program. See Surveillance, Epidemiology and End Results (SEER) program
Senate Finance Committee, 314.
See also Congress
Septicemia
oral sources of, leukemia/lymphoma patients, 252–255
prechemotherapy dental treatment, role in reduction of, leukemia/lymphoma patients, 255–256
See also Diseases and disorders;
Infectious agents
Sharp, Lesley, 317
Sirolimus, 295
Skin cancer
Breslow measurement technique, 177
diagnosis of, rates from screening, studies, 194–199, 201
diagnostic procedures, 47–48, 176, 178
diagnostic tests accuracy, 50, 179, 180, 181
disease burden, 25, 43–45, 59, 173–176
early detection through screening, compared to usual care, studies, 203
early detection through screening, evidence of benefits, 51–53, 172, 180, 181
epidemiology, 173–176
prevention, secondary, 38–39
prevention, tertiary, 39
suspicious lesions, rate of detection by screening, studies, 193–199
treatment, early, effectiveness of, results, 205–207, 208–209, 213
treatment, effective, availability of, 45–46
treatment effectiveness, 50–51, 60, 181
See also Diseases and disorders;
Melanoma;
Nonmelanoma skin cancers (NMSC);
Skin cancer screening
Skin cancer screening
ABCDE checklist for, 47, 49, 177, 189
accuracy of test, 48–50, 60, 172
adverse effects of, results, 203–204, 212
analytic framework, 178–181
benefits/harms, findings, 60
benefits/harms, issues, 25, 50–51
biopsies resulting from screening, statistics, 332
follow-up care/biopsies, rates of referral from screening, studies, 194–199, 201
follow-up referral procedure, effects on yield, studies, 202–203
case-finding programs, 178, 181
Committee on Medicare Coverage Extensions, objectives, 26–27
consequences of, analytic framework, 179, 181
consequences of, results, 193–205, 212
data extraction/synthesis methods, 182–184
diagnosis of, rates from, studies, 194–199, 201
early detection through, compared to usual care, studies, 203
early detection through, evidence of benefits, 51–53, 172, 180, 181
health outcome effects of, 60, 178, 179, 181
lead-time bias, 53
length bias, 53
literature review methods, 182
mass-screening programs, 178
Medicare coverage extension, access to/use of, impact on, 22, 23
Medicare coverage extension, assessment approach, 40–43
Medicare coverage extension, assessment criteria, 59–60
Medicare coverage extension, conclusions, 3–4, 62
Medicare coverage extension, cost estimates, 4, 25, 53–57, 330–336, 337
Medicare coverage extension, cost estimates, model, 55
Medicare coverage extension, cost estimates, statistics, 332, 334, 335, 337
Medicare coverage extension, costs, methodology, 331, 333, 336
Medicare coverage extension, findings, 58–61
Medicare coverage extension, intervention assessment, 25, 40–43
Medicare coverage extension, overview, xi, 2–3, 14, 25
Medicare coverage extension, pathway to, 59
Medicare coverage extension, rationales, 22
Medicare current coverage of, 3
melanoma, cost-effectiveness studies, results, 209–210
melanoma malignant lesions found, data on, 193, 200, 201
melanoma stages/mortality found in, comparison to usual practice, studies, 207–208
methods, 182–184
patient self-care and skin knowledge, effects on, results, 203
procedures, 46–47
recommendations on, 57–58, 178
recruitment strategy, effects on yield, studies, 202
research possibilities, 60–61
risk-assessment tools use for, accuracy, 189–193, 212
sensitivity of, definition, 48–49
skin examination type, effects on yield, studies, 202
specificity of, definition, 48, 49
suspicious lesions, rate of detection in, studies, 193–199, 201
total-body examination accuracy, screening/nonscreening studies results, 184–189, 212
yield of, program characteristics effects on, studies, 201, 202–203
See also Medical tests and procedures;
Melanoma;
Nonmelanoma skin cancers (NMSC);
Skin cancer
Social Security
disability benefits for end-stage renal disease patients, 321
Social Security Act of 1965 (SSA), 13, 15, 63, 226, 258, 266
Social Security Amendments of 1972, 287, 310–311, 322
Squamous cell carcinoma. See Nonmelanoma skin cancers (NMSC)
SSA. See Social Security Act of 1965 (SSA)
SSI. See Supplemental Security Income (SSI)
Starzl, Thomas E., 286
State Kidney Programs, 319
Supplemental Security Income (SSI)
renal transplant patients receiving, 318
Surgery
heart repair/replacement, dental care for, 84–85
heart repair/replacement, dental care for, Medicare coverage extension, cost estimates, 345
heart repair/replacement, dental care for, Medicare coverage extension, cost estimates, statistics, 348
heart repair/replacement, dental care for, Medicare coverage extension, costs, methodology, 347
heart repair/replacement, dental clinical/radiographic findings, 273
See also Medical tests and procedures;
Organ transplantation
Surveillance, Epidemiology and End Results (SEER) program, 44, 45, 52, 88, 173, 203, 210, 233–234, 340.
See also National Cancer Institute (NCI)
Sweden
Karolinska Institute, oral infections in bone marrow transplant patients, 254
melanoma incidence, 201
women, melanoma risk-assessment, 191–192
Tacrolimus, 292–293
Task Force on Preventive Services. See U.S. Preventive Services Task Force (USPSTF)
Technology assessment
Medicare coverage policy use of, 20, 132–133
Technology Assessment Office. See Office of Technology Assessment (OTA)
Teeth. See Decayed, missing and filled tooth surfaces (DMFS);
Dental care program (DCP);
Dental services;
Dental services, medically necessary;
Oral health
Texas, 240
Thurman, Karen, 322
Thymoglobulin®, 293–295
TNM. See Tumor, node, metastasis (TNM) system
Total-body skin examination, 184–189, 212
Transplant Amendments Act of 1990, 321
Transplantation. See Organ transplantation
Tumor, node, metastasis (TNM) system melanoma staging, 177, 203
UCLA. See University of California at Los Angeles (UCLA)
United Kingdom
Cheshire, melanoma risk assessment questionnaire, 192–193
London, renal transplant recipients, dental findings, 267
melanoma seven-point checklist, 176–177
osteoradionecrosis study, 245
Scotland, skin cancer screening, 208
Scotland, West of, skin health promotion campaign, 208
skin cancer screening, public information campaigns, 207, 208
United Network for Organ Sharing (UNOS), 87, 104, 259, 349, 360
Scientific Renal Transplant Registry, 288
United States Renal Data System (USRDS), 296
University of Alabama, 297
University of California at Los Angeles (UCLA), 244, 245
University of Chicago Hospitals, 256
University of Maryland Cancer Center, 256
University of Miami, 244
University of North Carolina. See Research Triangle Institute/University of North Carolina at Chapel Hill (RTI-UNC)
University of Pennsylvania Hospital Oncology Unit, 255
UNOS. See United Network for Organ Sharing (UNOS)
U.S. Preventive Services Task Force (USPSTF), 9, 10, 25, 31, 33, 40, 135, 172, 190–191
dental services, medically necessary, statement on, 89
preventive services recommended for persons 65 and older, listing, 130
preventive services recommended for persons 65 and older, Medicare coverage comparison, 9, 128–131
See also Guide to Clinical Preventive Services, Second Edition
USPSTF. See U.S. Preventive Services Task Force (USPSTF)
USRDS. See United States Renal Data System (USRDS)
Valvular heart disease
dental care for patients, 84–85, 268, 269
dental care for patients, benefits/harms, findings, 95
dental care for patients, Medicare coverage extension, conclusions, 97–98
dental care for patients, Medicare coverage extension, cost estimates, 86, 87, 345
dental care for patients, Medicare coverage extension, cost estimates, statistics, 348
dental care for patients, Medicare coverage extension, costs, methodology, 347
dental care for patients, Medicare coverage extension, findings, 94–95
dental care for patients, Medicare coverage extension, overview, 5, 67
dental care for patients, Medicare current coverage, 68, 230
dental care for patients, results, 271
dental care for patients, review methods, 270–271
Medicare diagnosis-related groups associated with, 270
Medicare discharges for, 271
Medicare utilization/reimbursement of, 270, 272
oral health problems associated with, 84, 225, 273
outcomes, dental care effectiveness for, 85, 94–95
See also Diseases and disorders
Veterans Administration, 258
Medical Centers, 56
Viruses. See Infectious agents
Walter Reed Army Medical Center, 74, 239, 240
West Virginia University, 243
Xerostomia. See Oral health
Years of healthy life (YHLs), 36
Zidovudine (AZT), 113