In the Journals

CT colonography coverage boosts CRC screening rates

Maureen A. Smith, MD, PhD
Maureen A. Smith

People are more likely to undergo colorectal cancer screening if their insurance policy covers computed tomographic colonography, according to new research.

The American Cancer Society recommends CT colonography, or virtual colonoscopy, as a less invasive alternative to colonoscopy for CRC screening in individuals aged 50 years and older, but it is not widely covered.

“CT colonography is a newer technology that can detect both pre-cancer and cancer, but because it’s relatively new it isn’t widely covered by insurance and isn’t covered by Medicare,” Maureen A. Smith, MD, PhD, MPH, from the University of Wisconsin-Madison School of Medicine and Public Health, said in a press release. “Our study suggests that when people are offered a greater choice of screening tests for colorectal cancer, including CT colonography, they are more likely to complete screening to prevent colorectal cancer.”

To compare overall CRC screening rates between patients with and without coverage for CT colonography, Smith and colleagues reviewed electronic health record data on 33,177 patients aged younger than 65 years and due for CRC screening who were managed at a large academic medical center from 2005 to 2010. Fifty-four percent of the patients were women, 9% were nonwhite, 69% were married and 52% completed screening of some kind during the study period.

The investigators found patients whose insurance covered CT colonography were 48% more likely to undergo screening with any method compared with patients whose insurance did not cover CT colonography (HR = 1.48; 95% CI, 1.41-1.55).

Patients with CT colonography coverage were also more likely to be screened with CT colonography (HR = 8.35; 95% CI, 7.11-9.82) and even with colonoscopy (HR = 1.38; 95% CI, 1.31-1.45), but not with fecal occult blood testing.

“Policymakers should consider additional options for screening and prevention of colorectal cancer,” Smith said in the press release, noting that this would especially benefit people in rural areas, racial and ethnic minorities, and those with lower incomes who tend to have lower screening rates. “CT colonography is potentially a powerful option, because there are people who will prefer it.”

She added that while some insurers have begun to cover CT colonography, Medicare is unlikely to do so any time soon.

“Locally, insurers have been open to including CT colonography in their coverage,” she said. “Nationally, any change will probably rely on Medicare’s decision-making process, which can take substantially more time.”

These findings support the U.S. Preventive Services Task Force (USPSTF) recommendations that more tests should be used to increase screening rates, and that Medicare should cover CT colonography for seniors, according to a statement from the American College of Radiology.

“Medicare coverage of virtual colonoscopy would boost screening and save lives,” Judy Yee, MD, chair of the American College of Radiology (ACR) Colon Cancer Committee, said in a press release. “It would help many seniors avoid extensive treatment and reduce costs. Virtual colonoscopy can both prevent cancer and detect cancer. Medicare should cover these exams.”

The press release noted that the American Cancer Society, the AGA, the Colon Cancer Alliance and Prevent Cancer Foundation also support coverage for CT colonography. – by Adam Leitenberger

Disclosures: Smith reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.

Maureen A. Smith, MD, PhD
Maureen A. Smith

People are more likely to undergo colorectal cancer screening if their insurance policy covers computed tomographic colonography, according to new research.

The American Cancer Society recommends CT colonography, or virtual colonoscopy, as a less invasive alternative to colonoscopy for CRC screening in individuals aged 50 years and older, but it is not widely covered.

“CT colonography is a newer technology that can detect both pre-cancer and cancer, but because it’s relatively new it isn’t widely covered by insurance and isn’t covered by Medicare,” Maureen A. Smith, MD, PhD, MPH, from the University of Wisconsin-Madison School of Medicine and Public Health, said in a press release. “Our study suggests that when people are offered a greater choice of screening tests for colorectal cancer, including CT colonography, they are more likely to complete screening to prevent colorectal cancer.”

To compare overall CRC screening rates between patients with and without coverage for CT colonography, Smith and colleagues reviewed electronic health record data on 33,177 patients aged younger than 65 years and due for CRC screening who were managed at a large academic medical center from 2005 to 2010. Fifty-four percent of the patients were women, 9% were nonwhite, 69% were married and 52% completed screening of some kind during the study period.

The investigators found patients whose insurance covered CT colonography were 48% more likely to undergo screening with any method compared with patients whose insurance did not cover CT colonography (HR = 1.48; 95% CI, 1.41-1.55).

Patients with CT colonography coverage were also more likely to be screened with CT colonography (HR = 8.35; 95% CI, 7.11-9.82) and even with colonoscopy (HR = 1.38; 95% CI, 1.31-1.45), but not with fecal occult blood testing.

“Policymakers should consider additional options for screening and prevention of colorectal cancer,” Smith said in the press release, noting that this would especially benefit people in rural areas, racial and ethnic minorities, and those with lower incomes who tend to have lower screening rates. “CT colonography is potentially a powerful option, because there are people who will prefer it.”

She added that while some insurers have begun to cover CT colonography, Medicare is unlikely to do so any time soon.

“Locally, insurers have been open to including CT colonography in their coverage,” she said. “Nationally, any change will probably rely on Medicare’s decision-making process, which can take substantially more time.”

These findings support the U.S. Preventive Services Task Force (USPSTF) recommendations that more tests should be used to increase screening rates, and that Medicare should cover CT colonography for seniors, according to a statement from the American College of Radiology.

“Medicare coverage of virtual colonoscopy would boost screening and save lives,” Judy Yee, MD, chair of the American College of Radiology (ACR) Colon Cancer Committee, said in a press release. “It would help many seniors avoid extensive treatment and reduce costs. Virtual colonoscopy can both prevent cancer and detect cancer. Medicare should cover these exams.”

The press release noted that the American Cancer Society, the AGA, the Colon Cancer Alliance and Prevent Cancer Foundation also support coverage for CT colonography. – by Adam Leitenberger

Disclosures: Smith reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.