Past Highlights: Colorectal

Medicare fully covers colorectal cancer (CRC) screening (screening colonoscopy, fecal immunochemical test, fecal occult blood test, multi-target stool DNA, and flexible sigmoidoscopy); however, if a biopsy or removal of a lesion occurs during the screening colonoscopy, the procedure becomes diagnostic. In addition, a colonoscopy that is performed after a positive stool test is coded as a diagnostic procedure regardless of colonoscopy findings. A diagnostic colonoscopy means the beneficiary may be charged co-insurance.^1,2 If waiving this co-insurance would result in a 10-percentage-point increase in adherence, MISCAN-Colon estimated there would be 13% fewer CRC deaths and approximately a 0.6% increase in CRC-related costs for the Centers for Medicare and Medicaid Services. Moreover, if removing the co-insurance increased the overall CRC screening rate by 0.6%, it would be considered cost-effective legislation. Therefore, the waiver is likely to have a favorable balance of health and cost impact. Methods and recommendations are described in more detail in Peterse et al., 2017.

¹ Medicare Coverage for Screening Colonoscopies

² Insurance Coverage for Colorectal Cancer Screening

These efforts were undertaken as a joint effort between multiple CISNET groups and US Government health policy makers which resulted in three reports to Centers for Medicare and Medicaid Services (CMS). One is a cost-effectiveness analysis of CT colonography, completed in 2009. Another is a cost-effectiveness analysis for the new stool DNA test, completed in 2007. The third is a cost-effectiveness analysis for the new immunochemical fecal occult blood tests (FOBT), completed in 2003.

Cost-Effectiveness of CT Colonography to Screen for Colorectal Cancer

CISNET members from Memorial Sloan-Kettering, University of Minnesota, Group Health Research Institute, and Erasmus MC worked together on the following report.

Zauber AG, Knudsen AB, Rutter CM, Lansdorp-Vogelaar I, Savarino JE, van Ballegooijen M, Kuntz KM. Cost-Effectiveness of CT Colonography to Screen for Colorectal Cancer: Report to the Agency for Healthcare Research and Quality from the Cancer Intervention and Surveillance Modeling Network (CISNET) for MISCAN, SimCRC, and CRC-SPIN Models. January 22, 2009. Available from: https://www.cms.gov/medicare-coverage-database/view/technology-assessments.aspx?TAId=58

Cost-Effectiveness of DNA Stool Testing to Screen for Colorectal Cancer

CISNET members from Harvard School of Public Health, Memorial Sloan-Kettering, and Erasmus MC worked together on the following report.

Zauber AG, Lansdorp-Vogelaar I, Wilschut J, Knudsen AB, van Ballegooijen M, Kuntz KM. Cost-effectiveness of DNA stool testing to screen for colorectal cancer: Report to AHRQ and CMS from the Cancer Intervention and Surveillance Modeling Network (CISNET) for MISCAN and SimCRC Models. December 20, 2007. Available from: https://www.cms.gov/medicare-coverage-database/search.aspx?redirect=Y&from=Overview&where=index&tid=52

Cost-Effectiveness of the Immunochemical Fecal Occult Blood Tests

CISNET members from Erasmus University and Memorial Sloan-Kettering worked together with NCI on the following report.

van Ballegooijen M, Habbema JDF, Boer R, Zauber AG, Brown ML. Report to the Agency for Healthcare Research and Quality: a comparison of the cost-effectiveness of fecal occult blood tests with different test characteristics in the context of annual screening in the Medicare population. August, 2003. Available from: https://www.cms.gov/medicare-coverage-database/view/technology-assessments.aspx?TAId=20