Survey: Radiologists choose colonoscopy over CTC, but not because of cost

Radiologists prefer colonoscopy over CT colonography (CTC) for colorectal cancer screening due to its effectiveness at detection and immediate biopsy capabilities, according to results of a study published in the February issue of the American Journal of Roentgenology.

While traditional colonoscopy remains the most commonly used method to screen for colorectal cancers, CTC has emerged as a less-invasive yet costly alternative, says lead author Adam Kaye, MD, and his colleagues from the Hospital of the University of Pennsylvania.

“CTC is less invasive than optical colonoscopy, is better for identifying polyps, and does not require sedation,” the authors wrote. “However, its cost-effectiveness has been called into question, and there is a residual need for OC if the CTC findings are positive.”

Kaye and his team wanted to better assess radiologists’ preferences regarding the two colorectal screening modalities and determine how value is assigned to various aspects of the screening process.

To do so, they showed a vignette to 42 radiologists in which colonoscopy was covered by an insurer at no charge while use of CTC required out-of-pocket payment. The participants were then asked a series of questions about how much they would be willing to pay for CTC, including hypothetical “what if” scenarios about CTC with perfect sensitivity, specificity and accuracy.

The results showed that when it comes to colorectal screening, radiologist preference has little to do with costs. Twenty-eight of the 42 radiologists surveyed chose colonoscopy over CTC, with a majority of respondents citing the accuracy and immediacy of the procedure as the deciding factor.

“Despite the less invasive nature of CTC, most radiologists who responded to the survey preferred (colonoscopy) for colorectal cancer screening,” wrote Kaye et al, “mostly because of the definitive nature of [colonoscopy] due to the capability of immediate biopsy of suspicious lesions and the lack of requirement for a second round of bowel preparation.”

Additionally, four radiologists indicated they would reverse their preference and choose CTC if it had 100 percent sensitivity, while 16 said they would prefer CTC if it had 100 percent specificity. Eliminating the need for bowel preparation would result in 57 percent of respondents choosing CTC over colonoscopy. The results also showed that 74 percent of the radiologists preferred perfect sensitivity to perfect specificity.

While ascertaining these insights into radiologists’ preferences is critical to enhancing care and improving the colorectal screening process, the choice is ultimately up to the patient, wrote Kaye and his colleagues.

“When the factors that drive preferences are understood, strategies can be developed to improve adherence and higher-value care can be delivered,” the authors concluded. “Screening is an individual decision. The role of the physician is to provide accurate information about the advantages and disadvantages of the screening modality.”