Search

Background: Healthcare costs in the U.S. are high and variable, which can hinder access and impact health outcomes across communities. This study examined hospital- and county-level characteristics to identify factors that explain geographic variation in prices for four cancer-related procedures. Methods: Data sources included Turquoise Health, which compiles publiclyavailable price data from U.S. hospitals. We examined list prices for four procedures: abdominal ultrasound, diagnostic colonoscopy, brain MRI, and pelvis CT scan, which we linked to characteristics of hospitals (e.g., number of beds) and counties (e.g., metropolitan status). We used multilevel linear regression models to assess multivariable relationships between prices and hospital- and countylevel characteristics. Supplementary analyses repeated these models using procedures prices for commercial insurance plans. Results: For each procedure, list prices varied across counties (intraclass correlation: abdominal ultrasound=23.2%; colonoscopy=17.1%; brain MRI=37.2%; pelvis CT=50.9%). List prices for each procedure were associated with hospital ownership (all p<0.001) and percent of population without health insurance (all p<0.05). For example, list prices for abdominal ultrasound were higher for proprietary versus Government-owned hospitals (β=539.10, 95% confidence interval [CI]: 256.12, 822.08, p<0.001) and for hospitals in counties with more uninsured residents (β=23.44, 95% CI: 2.55, 44.33, p=0.03). Commercial insurance prices were negatively associated with metropolitan status. Conclusions: Prices for cancer-related healthcare procedures varied substantially, with considerable heterogeneity associated with county location as well as county-level social determinants of health (e.g., health insurance coverage). Interventions and policy changes are needed to alleviate the financial burden of cancer care among patients, including geographic variation in prices for cancerrelated procedures. [ABSTRACT FROM AUTHOR]

A case of locally acquired (autochthonous) mosquito-transmitted Plasmodium vivax malaria was diagnosed in Arkansas in September 2023. This represents the 10th autochthonous case identified nationally in 2023, after 20 years without recorded local mosquitoborne malaria transmission in the United States. The public health response included case investigation, active case surveillance, mosquito surveillance and control, assessment of medical countermeasures, and clinical and public outreach. Prompt diagnosis and appropriate treatment of malaria can improve clinical outcomes and, in addition to vector control, minimize risk for local transmission. Clinicians should consider malaria among patients who have traveled to countries where malaria is endemic, or with unexplained fever regardless of travel history. Although the risk for autochthonous malaria in the United States remains very low, its reemergence highlights the importance of vectorborne disease preparedness and response. Examples of such efforts include improving awareness among clinicians, access to diagnostics and antimalarial medications, and capacity for mosquito surveillance and control. Collaboration and communication among CDC, health departments, local jurisdictions, clinicians, hospitals, laboratories, and the public can support rapid malaria diagnosis, prevention, and control. Before traveling internationally to areas where malaria is endemic, travelers should consult with their health care provider regarding recommended malaria prevention measures, including chemoprophylaxis and precautions to avoid mosquito bites, to reduce both personal and community risk., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Alison D. Ridpath reports ownership of stocks in the following companies: Johnson & Johnson, BioNtech SE, Protagonist Therapeutics, Imminic, Inc., Infinity Pharmaceuticals, Inc., Pfizer, Inc., Merck and Co., Inc., Amgen. Inc., and IQVIA Holdings, Inc. Bobby L. Boyanton Jr. reports receipt of consulting fees from Guidepoint Global, MedAvers, and QuidelOrtho, payment or honoraria from QuidelOrtho, and application for a patent from Siemens Atellica Instruments. No other potential conflicts of interest were disclosed.