Cost Differences After Initial CT Colonography Versus Optical Colonoscopy in the Elderly.

Area of Science:

• Gastroenterology
• Radiology
• Health Economics

Background:

• Medicare costs associated with colorectal cancer screening methods are a significant concern for healthcare payers.
• Computed tomographic colonography (CTC) and optical colonoscopy (OC) are both used for colorectal cancer screening in asymptomatic individuals.

Purpose of the Study:

• To compare Medicare costs incurred one year after initial computed tomographic colonography (CTC) versus initial optical colonoscopy (OC) in asymptomatic Medicare outpatients aged 66 years and older.

Main Methods:

• A retrospective cohort study was conducted using Medicare data from January 2007 to December 2008.
• Asymptomatic outpatients aged ≥ 66 who received initial CTC (n = 531) or OC (n = 17,593) were included. OC patients were matched by county and screening year.
• Outcomes measured included total inpatient and outpatient Medicare costs, and costs of outpatient testing for potential findings in the colon, abdomen, pelvis, and lungs within one year post-procedure.

Main Results:

• Patients undergoing initial CTC incurred higher adjusted outpatient testing costs for colonic ($50) and extracolonic ($64) findings compared to those undergoing initial OC.
• No significant differences were observed in adjusted total Medicare costs per patient ($2065) one year after initial CTC versus OC.
• Adjusted inpatient and outpatient costs also did not differ significantly between the CTC and OC cohorts.

Conclusions:

• Despite higher downstream outpatient testing costs associated with findings from CTC, the overall Medicare costs one year after initial CTC or OC are comparable for asymptomatic elderly patients.
• These findings suggest that, from a payer's perspective, CTC and OC generate similar total healthcare expenditures, even though Medicare currently does not cover screening CTC.