Thursday, August 19, 1999
Improved Pap test resisted by insurers
BY SUE MacDONALD
The Cincinnati Enquirer
More doctors are offering women a new gernation Pap test to screen for cervical cancer, bu some women are ending up paying for it themselves.
The ThinPrep Test, adopted in August 1998 by Anthem Blue Cross & Blue Shield and in January by Health Alliance Hospitals, involves a new way of collecting and reading cell samples to determine whether a woman has signs of cervical cancer.
But women enrolled in ChoiceCare/Humana insurance plans must pay $40 or more for ThinPrep because Humana's technical evaluators say the scientific evidence doesn't exist to support the test's higher cost. A standard Pap test is about $24.
Dr. Randy Stinger, associate medical director for ChoiceCare/Humana, says the company's goal is not to choose one laboratory test over another but to encourage all women - especially those at high risk of cervical cancer - to get a Pap test every year.
If it were up to the laboratory specialists who read the slides, all doctors would switch to ThinPrep and all insurance companies would pay for it. At the least, women need to know it's an option, says Karen Henderson, supervisor of anatomic pathology for TriHealth, the health collaborative of Bethesda and Good Samaritan hospitals.
"The Pap test has been around since the 1950s, and ThinPrep is the first improvement to the Pap test since that time," she says. "We're very excited about it."
How it works
Until ThinPrep was introduced in 1996, all Paps were conducted the same way. The doctor would scrape cells from the woman's cervix, smear them on a glass slide and send the slide to a laboratory where technicians would examine the cells for signs of cancer.
With ThinPrep, the doctor uses a small brush to remove cells from a woman's cervix and rinses the brush in a vial of special liquid. The vial is sent to the laboratory, where it's filtered so that only the cells remain — blood and bits of tissue commonly found on Pap smear slides are removed.
“The difference is like night and day,” Ms. Henderson says. “It cleans up the sample and makes it so much easier for the person who is screening Pap smears all day to find that needle in a haystack. We would love to see all of our clients go 100 percent (ThinPrep), but right now the biggest limiting factor is reimbursement from health-care providers.”
Almost 150 insurers representing 100 million members now pay for ThinPrep, including Prudential, Cigna and United Healthcare, says Jeff Keene, director of corporate communications for Cytyc, the company that makes ThinPrep.
But managed care plans and insurers can decide what they will and won't pay for, as evidenced by Anthem's recent decision to not cover new FDA-approved drugs or medical devices for at least six months as one way of holding down rising health costs, especially the costs of prescription drugs.
ThinPrep more accurate
Laboratory technologists say ThinPrep also provides a more accurate sense of whether a woman has cancer because the cells are not clumped together or obscured by blood and tissue. A more accurate test also means fewer women have to be re-tested or undergo a biopsy to clear up suspicious or questionable Pap results, Ms. Henderson says.
In 1998, federal health regulators called ThinPrep “significantly more effective” than the traditional Pap smear, which has a 15 percent to 20 percent chance of missing a woman's cancer.
“For women, I think it's definitely an exciting test,” Ms. Henderson says. “For cytotechnology in general, it's probably one of the first major improvements to the Pap test in years. We're finding at TriHealth that our less-than-optimal rate — meaning we have to redo a Pap — has dropped from 10 percent to an average of about 3 percent.”
Dr. Derek van Amerongen, national medical director for Anthem, says his company decided to cover ThinPrep last year because it “was as good as the standard Pap smear.”
Because the Pap test is a screening tool, however, he also says it's more important for women to get screened regularly than it is to debate which test is used, because early detection of cervical cancer greatly increases a woman's chance of survival. Both the standard Pap and ThinPrep will detect cancer. About 12,800 women are diagnosed with cervical cancer each year and about 4,800 die, according to the American Cancer Society.
“It's not controversial to go in and get a cervical screening,” Dr. van Amerongen says. “We hope the primary message is that more people need to get in to get screened.”
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