Colorectal Testing Utilization and Payments in a Large Cohort of Commercially Insured US Adults

Ladabaum, Uri; Levin, Zachary; Mannalithara, Ajitha; Brill, Joel V.; Bundorf, M. Kate

doi:10.1038/ajg.2014.64

Cited by 34 publications

(42 citation statements)

References 40 publications

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“…The costs for MTsDNA were based on Medicare reimbursement rates for persons age ≥65, and rates for commercial insurer carriers for persons age 50-64. 37 Based on the mean ratio of commercial to Medicare payment rates for colorectal tests, 18 we assumed CRC care and complication costs for persons age 50-64 that were 1.35-fold those of persons age ≥65. "Patient support" costs were derived from the CDC's Colorectal Cancer Screening Demonstration Program.…”

Section: Cost Inputsmentioning

confidence: 99%

“…Base case cost inputs were derived from Medicare reimbursement rates 33-35 and estimated CRC care costs 36 for persons age ≥65, and from commercial payment rates in persons age 50-64, 18 accounting for colonoscopy site of service, 18,36 and updated to 2015 dollars using the medical component of the consumer price index (Table 1 and Appendix). The costs for MTsDNA were based on Medicare reimbursement rates for persons age ≥65, and rates for commercial insurer carriers for persons age 50-64.…”

Section: Cost Inputsmentioning

confidence: 99%

“…However, previous studies have not addressed comprehensively the complex patterns of screening participation over time that are now being described (consistent screeners, late entrants, dropouts, intermittent screeners, consistent non-responders), 12,13 the "patient support" costs that are required to realize the higher participation rates that organized programs achieve compared with opportunistic screening, 14,15 the possibility that one-time test performance characteristics may overestimate the ability of tests to detect lesions that were missed in previous rounds of testing, 6,16,17 and the higher payment rates by commercial insurers compared with Medicare. 18 Our aims were to explore the potential effectiveness and cost-effectiveness of screening for colorectal neoplasia with MT-sDNA compared with the most established current strategies, M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 5 FIT and colonoscopy. We performed a decision analytic health economic evaluation including scenarios with optimal patient participation or complex longitudinal participation patterns as reported in the real world, allowing for differential participation rates among strategies, and incorporating the additional critical factors identified above.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Effectiveness and Cost Effectiveness of a Multitarget Stool DNA Test to Screen for Colorectal Neoplasia

2016

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In a Markov model, we found FIT and colonoscopy to be more effective and less costly than the MT-sDNA test when participation rates were equal for all strategies. For the MT-sDNA test to be cost effective, the patient support program included in its cost would need to achieve substantially higher participation rates than those of FIT, whether in organized programs or under the opportunistic screening setting that is more common in the United States than in the rest of the world.

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Section: Cost Inputsmentioning

confidence: 99%

Section: Cost Inputsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparative Effectiveness and Cost Effectiveness of a Multitarget Stool DNA Test to Screen for Colorectal Neoplasia

2016

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“…We studied the barriers to routine CRC screening in an “insured population” which might predict who will be screened in the future. Even though a larger percentage of adults are becoming “insured”, the “out-of-pocket” costs for CRC screening might also affect the screening rate[14]. There is a limited data on the barriers to screening in insured adults, but “out-of-pocket costs” appear to be emerging as an essential factor in the prediction of screening[15].…”

Section: Introductionmentioning

confidence: 99%

Colorectal cancer screening use among insured adults: Is out-of-pocket cost a barrier to routine screening?

Perisetti

Khan

George

et al. 2018

WJGPT

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AIMTo describe the characteristics of adults who needed to see a doctor in the past year but could not due to the extra cost and assess the impact of limited financial resources on the receipt of routine fecal occult blood test, sigmoidoscopy, or colonoscopy for colon cancer screening among insured patients.METHODSData obtained from the 2012 Behavioral Risk Factor Surveillance System included 215436 insured adults age 50-75 years. We computed frequencies, adjusted odds ratios (aORs), and 95%CIs using SAS v9.3 software.RESULTSNine percent of the study population needed to see a doctor in the past year but could not because of cost. The numbers were significantly higher among those aged 50-64 (P < 0.0001), Non-Hispanic Whites (P < 0.0001), and those with a primary care physician (P < 0.0001) among other factors. Adjusting for possible confounders, aORs for not seeing the doctor in the past year because of cost were: stool occult blood test within last year aOR = 0.88; 95%CI: 0.76-1.02, sigmoidoscopy within last year aOR = 0.72; 95%CI: 0.48-1.07, colonoscopy within the last year aOR = 0.91; 95%CI: 0.81-1.02.CONCLUSIONWe found that the limited financial resources within the past 12 mo were significantly associated with colorectal cancer (CRC) non-screening. Patients with risk factors identified in this study should adhere to CRC guidelines and should receive financial help if needed.

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“…Costs associated with FOBT were generally low, which likely translated into small or no out-of-pocket expenses. 12 Medicare has covered colorectal cancer screening since 1998. 13 Prior to the ACA, FOBT was covered without a deductible or copayment.…”

Section: Introductionmentioning

confidence: 99%

Colorectal Cancer Screening in the Era of the Affordable Care Act

et al. 2015

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BACKGROUND:The Affordable Care Act (ACA) eliminated cost-sharing for evidence-based preventive services in an effort to encourage use. OBJECTIVE: To evaluate use of colorectal cancer (CRC) screening in a national population-based sample before and after implementation of the ACA. DESIGN: Repeated cross-sectional analysis of the Medical Expenditure Panel Survey (MEPS) between 2009 and 2012 comparing CRC screening rates before and after implementation of the ACA. PARTICIPANTS: Adults 50-64 with private health insurance and adults 65-75 with Medicare. MAIN MEASURES: Self-reported receipt of screening colonoscopy, sigmoidoscopy, or fecal occult blood test (FOBT) within the past year among those eligible for screening. KEY RESULTS: Our study included 8617 adults aged 50-64 and 3761 adults aged 65-75. MEPS response rates ranged from 58 to 63%. Among adults aged 50-64, 18.9-20.9% received a colonoscopy in the survey year, 0.59-2.1% received a sigmoidoscopy, and 7.9-10.4% received an FOBT. For adults aged 65-75, 23.6-27.7% received a colonoscopy, 1.3-3.2% a sigmoidoscopy, and 13.5-16.4% an FOBT. In adjusted analyses, among participants aged 50-64, there was no increase in yearly rates of colonoscopy (−0.28 percentage points, 95% CI −2.3 to 1.7, p=0.78), sigmoidoscopy (−1.1%, 95% CI −1.7 to −0.46, p=<0.001), or FOBT (−1.6%, 95% CI −3.2 to −0.03, p=0.046) post-ACA. For those aged 65-75, rates of colonoscopy (+2.3%, 95% CI −1.4 to 6.0, p=0.22), sigmoidoscopy (+0.34%, 95% CI 0.88 to 1.6, p=0.58) and FOBT (−0.65, 95% CI −4.1 to 2.8, p=0.72) did not increase. Among those aged 65-75 with Medicare and no additional insurance, the use of colonoscopy rose by 12.0% (95% CI 3.3 to 20.8, p = 0.007). Among participants with Medicare living in poverty, colonoscopy use also increased (+5.7%, 95% CI 0.18 to 11.3, p=0.043). CONCLUSIONS: Eliminating cost-sharing for CRC screening has not resulted in changes in the use of CRC screening services for many Americans, although use may have increased in the post-ACA period among some Medicare beneficiaries.KEY WORDS: colorectal cancer; health care reform; health insurance; preventive care.

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Colorectal Testing Utilization and Payments in a Large Cohort of Commercially Insured US Adults

Cited by 34 publications

References 40 publications

Comparative Effectiveness and Cost Effectiveness of a Multitarget Stool DNA Test to Screen for Colorectal Neoplasia

Comparative Effectiveness and Cost Effectiveness of a Multitarget Stool DNA Test to Screen for Colorectal Neoplasia

Colorectal cancer screening use among insured adults: Is out-of-pocket cost a barrier to routine screening?

Colorectal Cancer Screening in the Era of the Affordable Care Act

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