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Pages 367-392

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From page 367...
... Preventive Services Task Force recommendations/Medicare coverage comparison, 9, 128-131 skin cancer and, 172, 173 367 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)
From page 368...
... British Columbia. See Canada Burden of disease, 25 head/neck cancer, 69-71, 91 heart valve repair/replacement, 83-85, 94 immunosuppressive drugs for transplant patients, drug noncompliance, 124 leukemia, 75-76, 92, 249 lymphoma, 76-77, 93, 25~251 melanoma, 43~4, 173-174 nonmelanoma skin cancers, 44~5, 175176 skin cancer?
From page 369...
... 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, 3233 health outcomes v.
From page 370...
... , 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)
From page 371...
... ; 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, 232233 decision framework for, 231-232 definition of, 65-66, 223-224 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, 235 371 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, care for, 78-80, 247, 248-249
From page 372...
... See Dental care program (DCP) ; Dental services; Dental services, medically necessary; Oral health Department of Health and Human Services (DHHS)
From page 373...
... 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, 132133, 136 preventive services, Medicare coverage of, overview of,9-10,127-131,136 Evidence-Based Medicine Working Group, 29 Evidence-Based Practice Centers (EPCs)
From page 374...
... 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
From page 375...
... 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 375 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, 8588, 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, 8588, 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,
From page 376...
... , 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, 1819,127-128,130,131,134,135,139 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, 317318, 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.
From page 377...
... 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; Immunosuppress~ve 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
From page 378...
... , 81, 291 leukemia/lymphoma and, 250, 253, 254, 255 septicemia oral sources for leukemia/ lymphoma patients, 252-255 transplantation and, 26~262 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, 1011, 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)
From page 379...
... ; 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, 249 379 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 treatment for, 76, 78 See also Diseases and disorders Lewin Group, 53, 118, 323, 329 Los Angeles, California.
From page 380...
... 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 INDEX 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, 4546 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, 1819 cost/cost-effectiveness analysis, decisionmaking role of, 134-136, 139 Coverage Issues Manual, 227 decisionmaking, overview on, 8-11, 1822, 131-136 dental services, current coverage, 5, 6365, 68, 22~228, 230 dental services, medically necessary, coverage extension, xi, ~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
From page 381...
... INDEX 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, decisionmaking role of, 2, 9-10, 20,127-131, 132-133, 136 extension of coverage, rationales for,2223 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, 347 381 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
From page 382...
... . 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, 312313 transplantation, 1994 policy, 314-315, 318-320 transplantation, potential modifications to program, 320-324
From page 383...
... 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, 18~193 staging, 177 treatment, availability of, 45~6 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 383 Methods and methodology analytic strategy, 27, 29-33 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, 270271 immunosuppressive drugs for transplant patients, Medicare limit elimination, assessment, 10)
From page 384...
... 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, 122123 skin cancer screening, Medicare coverage extension, cost estimates, 55 Mortality dialysis v.
From page 385...
... 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
From page 386...
... , 313 Organ transplantation acute rejection, 106, 107 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 chronic rejection, 106, 107 corticosteroids, immunosuppressive use of, 292 costs of, 29~298 cyclosporine, immunosuppressive use of, 292, 293 dental care and, after surgery, 82, 265266, 267 dental care and, before surgery, 82, 263264, 267 dental care and, benefits/harms, 94, 267 dental care and, committee findings, 9394 dental care and, Medicare coverage extension, 5, 67, 257-259, 268 dental care and, Medicare coverage extension, committee conclusions, 97-98 INDEX 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 .
From page 387...
... ; Medical tests and procedures; Surgery Organ Transplantation National Task Force. See National Task Force on Organ Transplantation Osteoradionecrosis (ORN)
From page 388...
... See Burden of disease Preventive health care Medicare coverage, 8-11, 14 Medicare coverage, health outcome lim its of, 2, 12, 13~138 Medicare coverage, evidence-based as sessment and, 9-10, 127-131, 136 INDEX 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.
From page 389...
... See Conclusions and findings Relative value unit (RVU) , 331 Rennie, D., 286 Research dental services, medically necessary, 9596 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 (RTIUNC)
From page 390...
... , 13, 15, 63, 226, 258, 266 Social Security Amendments of 1972, 287, 310-311, 322 Squamous cell carcinoma. See Nonmelanoma skin cancers (NMSC)
From page 391...
... 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)
From page 392...
... Valvular heart disease burden of disease, 83-84, 94 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 INDEX dental care for patients, results, 271 dental care for patients, review methods, 27~271 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.


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