Document Detail

Cost-effectiveness of computed tomographic colonography screening for colorectal cancer in the medicare population.
MedLine Citation:
PMID:  20664028     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) considered whether to reimburse computed tomographic colonography (CTC) for colorectal cancer screening of Medicare enrollees. To help inform its decision, we evaluated the reimbursement rate at which CTC screening could be cost-effective compared with the colorectal cancer screening tests that are currently reimbursed by CMS and are included in most colorectal cancer screening guidelines, namely annual fecal occult blood test (FOBT), flexible sigmoidoscopy every 5 years, flexible sigmoidoscopy every 5 years in conjunction with annual FOBT, and colonoscopy every 10 years.
METHODS: We used three independently developed microsimulation models to assess the health outcomes and costs associated with CTC screening and with currently reimbursed colorectal cancer screening tests among the average-risk Medicare population. We assumed that CTC was performed every 5 years (using test characteristics from either a Department of Defense CTC study or the National CTC Trial) and that individuals with findings of 6 mm or larger were referred to colonoscopy. We computed incremental cost-effectiveness ratios for the currently reimbursed screening tests and calculated the maximum cost per scan (ie, the threshold cost) for the CTC strategy to lie on the efficient frontier. Sensitivity analyses were performed on key parameters and assumptions.
RESULTS: Assuming perfect adherence with all tests, the undiscounted number life-years gained from CTC screening ranged from 143 to 178 per 1000 65-year-olds, which was slightly less than the number of life-years gained from 10-yearly colonoscopy (152-185 per 1000 65-year-olds) and comparable to that from 5-yearly sigmoidoscopy with annual FOBT (149-177 per 1000 65-year-olds). If CTC screening was reimbursed at $488 per scan (slightly less than the reimbursement for a colonoscopy without polypectomy), it would be the most costly strategy. CTC screening could be cost-effective at $108-$205 per scan, depending on the microsimulation model used. Sensitivity analyses showed that if relative adherence to CTC screening was 25% higher than adherence to other tests, it could be cost-effective if reimbursed at $488 per scan.
CONCLUSIONS: CTC could be a cost-effective option for colorectal cancer screening among Medicare enrollees if the reimbursement rate per scan is substantially less than that for colonoscopy or if a large proportion of otherwise unscreened persons were to undergo screening by CTC.
Amy B Knudsen; Iris Lansdorp-Vogelaar; Carolyn M Rutter; James E Savarino; Marjolein van Ballegooijen; Karen M Kuntz; Ann G Zauber
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-07-27
Journal Detail:
Title:  Journal of the National Cancer Institute     Volume:  102     ISSN:  1460-2105     ISO Abbreviation:  J. Natl. Cancer Inst.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-18     Completed Date:  2010-08-31     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  7503089     Medline TA:  J Natl Cancer Inst     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1238-52     Citation Subset:  IM    
Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114.
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MeSH Terms
Aged, 80 and over
Colonography, Computed Tomographic / economics*
Colonoscopy / economics
Colorectal Neoplasms / economics*,  radiography*
Cost-Benefit Analysis
Direct Service Costs / statistics & numerical data*
Mass Screening / economics*,  methods*
Occult Blood
Patient Compliance
Population Surveillance / methods
Sensitivity and Specificity
United States
Grant Support
U01-CA-088204/CA/NCI NIH HHS; U01-CA-097426/CA/NCI NIH HHS; U01-CA-097427/CA/NCI NIH HHS; U01-CA-115953/CA/NCI NIH HHS
Comment In:
J Natl Cancer Inst. 2010 Nov 3;102(21):1676; author reply 1676-7   [PMID:  20876419 ]
J Natl Cancer Inst. 2010 Aug 18;102(16):1212-4   [PMID:  20651321 ]

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