Colorectal cancer screening cost and utilization is subject to much public scrutiny, but little data exists on the payments and use of these procedures amongst commercially insured patients.
A study published in The American Journal of Gastroenterology examined the payments, indications and utilization rates of colorectal cancer screening tests amongst 21 million patients with group health insurance provided by 160 self-insured employers. Here are 11 things to know about the results:
• Of the adults aged 50 years to 64 years, 12 percent underwent colonoscopy in one year.
• The majority of colonoscopies and fecal tests were related to screening and surveillance indications.
• Testing rates were higher in women than in men and rose with age.
• Mean payments for fecal occult blood tests were $5.
• Mean payments for immunochemical tests were $21.
• Mean payments for a diagnostic colonoscopy in an office were $586.
• Mean payments for a diagnostic colonoscopy in a hospital outpatient facility were $1,400.
• Mean payments for diagnostic colonoscopy in an ambulatory surgery center were $1,074.
• Mean payments for anesthesia services were $494.
• Mean payments for pathology services were $272.
• Mean payments for the most frequently used colonoscopy codes were 1.4 to 1.9 times the average Medicare payments.
Traditional models of colorectal cancer screening cost-effectiveness have been based on Medicare payments. The researchers concluded that cost-effectiveness may differ when taking into consideration payment from commercial insurers.