Out-of-Pocket Costs for Colonoscopy After Noninvasive Colorectal Cancer Screening Among US Adults With Commercial and Medicare Insurance

Abstract

This economic evaluation examines whether adult patients in the US who have commercial or Medicare insurance pay out-of-pocket costs associated with follow-up colonoscopy within 6 months of a noninvasive stool-based test.

Comparison of Screening Colonoscopy Rates After Positive Noninvasive Testing for Colorectal Cancer in States With and Without Cost-Sharing

“…However, cost barriers remain for some individuals with a positive test that requires a follow-up colonoscopy. 1 In response, state-level policies have been enacted in Kentucky (2016), Oregon (2017), and California (2021) to eliminate financial disincentives that may deter follow-up colonoscopy for these individuals. In January 2022, federal guidance was issued to remove cost-sharing for colonoscopies following noninvasive CRC screening tests for commercial insurers, and a similar policy is under consideration for Medicare.…”

Life-years gained resulting from screening colonoscopy compared with follow-up colonoscopy after a positive stool-based colorectal screening test

“…Colonoscopy is an essential tool in the effort to reduce CRC burden. Unfortunately, many Americans face cost-sharing for a clinically indicated colonoscopy following a positive stool-based test, which may deter use of this potentially life-saving intervention ( Fendrick et al, 2021b ). The estimated LYG/colonoscopy was approximately 3-fold higher for procedures performed in follow-up of a positive stool-based screening test when compared with screening colonoscopy.…”

“…However, cost barriers remain for some individuals with an initial positive stool-based test that requires a follow-up colonoscopy to complete the CRC screening process. Coverage policies that impose this type of financial disincentive may deter CRC screening participation ( Fendrick et al, 2021b ). The objective of this analysis was to estimate and compare the life-years gained (LYG) per average-risk screening colonoscopy and follow-up colonoscopy after a positive stool-based test to better inform CRC coverage policy and reimbursement decisions.…”

Reducing the Burden of Colorectal Cancer: AGA Position Statements

“…18 Nevertheless, there is evidence that consumer cost sharing remains common. Fendrick et al 19 recently found that cost sharing for CRC screening occurred in 48.2% of patients with commercial insurance and 77.9% of patients with Medicare coverage.…”