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

中文翻译：

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布雷德伍德诉贝塞拉案最初裁决对结直肠癌结果的影响：一项模型研究


《平价医疗法案》(ACA) 取消了 USPSTF 推荐服务的患者费用分摊。然而，如果美国第五巡回上诉法院完全支持美国地方法院在 Braidwood Management v. Becerra, 666 F. Supp. 案中的裁决。 3d 613 (ND Tex 2023)，ACA 通过后提出的 USPSTF 建议的费用分摊将恢复到超过 1.5 亿人。该案例仍可恢复 45-49 岁结直肠癌 (CRC) 筛查的费用分摊，以及所有年龄段（诊断性）结肠镜检查期间息肉切除的费用分摊。使用 MISCAN-Colon 模型，我们模拟了对 CRC 结果的潜在影响，假设早发 CRC 趋势和较低的筛查参与率。筛查参与率下降 8 个百分点可能会使 CRC 发病率增加 5.1%，CRC 死亡率增加 9.1%，而由于费用分摊增加，成本略有下降。筛查参与率大幅下降可能会因发病率增加和诊断延迟而导致成本更高。