CT Colonography Cost-effective for Medicare Enrollees

Veronica Hackethal, MD

October 05, 2015

CT colonography (CTC) is more cost-effective than conventional optical colonoscopy and could decrease Medicare costs for colorectal cancer screening, according to a study published online September 9 in Abdominal Imaging.

"The findings confirm that [CTC] hits upon the 'triple aim' that Medicare policies strive to achieve — it improves the patient experience as no anesthesia is required, allowing for immediate resumption of daily activities; as an effective screening tool for colon cancer, it improves population health; and it reduces the cost per capita of health care," Patrick Hope, JD, executive director of the Medical Imaging and Technology Alliance, said in a news release. "We hope this data will encourage the Centers for Medicare & Medicaid Services to cover this service as it will grant more American seniors access to a cost-effective tool to detect colon cancer early, when it is more treatable," he continued.

The US Preventive Services Task Force is reviewing evidence for colorectal cancer screening, which includes looking at the efficacy of CTC. Some experts believe the task force will assign CTC an A or B grade, which would require private health insurances, Medicaid, and Affordable Care Act insurances, but not Medicare, to cover it. Medicare coverage of CTC, however, could improve adherence to American Cancer Society colorectal cancer screening guidelines, as well as patient satisfaction. Compared with colonoscopy, CTC is less invasive, has fewer complications, and requires no anesthesia and no need for an escort after the procedure, according to background information in the article.

Large multisite national and international trials have shown that CTC is similar in clinical efficacy to standard colonoscopy, according to Judy Yee, MD. Dr Yee, who was not involved in the study, is professor and vice chair of radiology and biomedical imaging at the University of California, San Francisco, and chair of the American College of Radiology Colon Cancer Committee. These trials have shown that CTC has a sensitivity of more than 90% for detecting polyps 10 mm or larger, which are most likely to be malignant, and about 80% to 85% for small 6- to 9-mm polyps, which have a low malignancy risk, she said.

In the current study, Bruce Pyenson, from Milliman Inc, and colleagues used Medicare claims data, fee schedules, current clinical guidelines from several societies, and other sources to evaluate screening costs comparing CTC with colonoscopy. The estimates included costs for patients who would need rescreening with traditional colonoscopy and cost-effectiveness of extracolonic findings. Researchers used simulation modeling to compare Medicare costs for patients who complied with screening recommendations for CTC and conventional colonoscopy. They also tested alternative scenarios and adjusted 2013 Medicare claims to reflect 2015 costs.

The analysis included 56,578 Medicare screening colonoscopies. Cost estimates showed that an average conventional colonoscopy screening cost $1036, and an average CTC screening cost $439. Fully screening all Medicare enrollees with conventional colonoscopy would cost $5.7 billion compared with $4.0 billion for CTC, suggesting CTC would cost 29% less than conventional colonoscopy.

Simulations looking at nine different scenarios that could affect costs showed savings between 12% and 58% for CTC compared with conventional colonoscopy.

The study assumed that Medicare reimbursement will be the same for a screening CTC as it is for a diagnostic CTC without intravenous contrast, which may not be true because diagnostic CTCs could justify higher reimbursement, according to Dr Yee.

"Even if this is the case, lower reimbursements for screening tests would correlate with CTC being even more cost-effective," she told Medscape Medical News.

"To achieve a significant increase in colon cancer screening compliance in the aging American population, additional tests need to be made available to the public that will bring them in for testing," Dr Yee emphasized. "CTC has been around for over 20 years and has a proven safety record. It offers a less invasive and accurate test for colorectal cancer screening that can help increase screening rates and save lives."

One coauthor reports being a cofounder of VirtuoCTC and shareholder in Cellectar Biosciences. The other authors and Dr Yee have disclosed no relevant financial relationships.

Abdom Imaging, Published online September 9, 2015. Full text

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