CRC screening estimates miss the mark by excluding virtual colonoscopy

Including virtual colonoscopy as a Healthcare Effectiveness Data and Information Set (HEDIS)-compliant colorectal cancer (CRC) screening test could raise overall screening rates, according to a study published in the January issue of the Journal of the American College of Radiology.

Although virtual colonoscopy, or CT colonography (CTC), is included in recent screening guidelines jointly released by the American Cancer Society, the American College of Radiology and the U.S. Multi-Society Task Force on Colorectal Cancer, it has yet to be included as a qualifying test in HEDIS by the National Committee for Quality Assurance. HEDIS was designed as a tool to measure the quality of health plans by evaluating how well plans follow current evidence-based guidelines, explained authors Brooks D. Cash, MD, of Walter Reed National Military Medical Center in Bethesda, Md., and colleagues.

Currently, only three CRC tests—fecal occult blood testing, flexible sigmoidoscopy and colonoscopy—can fulfill the HEDIS measure, but the authors pointed to the benefits of including CTC as well. “As a time-efficient and minimally invasive screening test, it holds promise to improve patient compliance for CRC screening. A recent analysis using various cost-effectiveness microsimulation models showed CTC to be a favorable option for CRC screening in the Medicare-aged population,” they wrote.

To quantify the use of CTC for CRC screening and demonstrate the potential impact of including it as a HEDIS-acceptable screening modality, Cash and colleagues analyzed demographic and healthcare utilization data from the Military Health System Population Health Portal. Data on overall utilization of CTC from Jan. 1, 2005, through Dec. 31, 2010, for individuals aged 50 to 75 years were included in the study, and HEDIS screening compliance was estimated. Incremental impact of adding HEDIS-eligible patients who had undergone CTC as their only CRC screening test was then evaluated for two similarly sized, regional Navy medical centers.

Across the 17 included sites, 17,187 CTC studies were performed, with increasing utilization during the study period. At the two Navy medical centers, screening compliance ranged from 33.8 percent to 67.9 percent without CTC and 33.8 percent to 84 percent with CTC.

“Our findings suggest that these screening rates (based on the current HEDIS definition) underestimate actual CRC screening compliance to the extent that the recommended alternative of CTC is used in lieu of other CRC screening tests within a given population,” wrote the authors.

They added that despite the fact that implementation of the HEDIS measure has driven practice changes, national CRC screening goals will likely not be met if the list of eligible exams remains limited to the three currently specified in the HEDIS metrics.