AJR: Lack of insurance coverage could prohibit wider CTC screening

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Patients who have previously refused colorectal cancer screening are willing to undergo CT colonography (CTC), or virtual colonoscopy, but are not willing to pay for the exam themselves when not covered by insurance, according to a study in the August issue of the American Journal of Roentgenology.

Wendy Ho, MD, from the gastrointestinal unit at Massachusetts General Hospital in Boston, and colleagues undertook the study to evaluate patients’ barriers against colorectal cancer screening tests and to assess patients’ preferences and cost influences for CTC in a non-adherent urban subpopulation.

The researchers asked 175 patients who had been offered colorectal cancer screening but were non-adherent to fill out a questionnaire. Fifty-three declined and 54 did not respond, which left 68 subjects to be included in the analysis.

The investigators obtained patients’ demographics, and their reasons for not being screened were explored. Also, subjects were given an information sheet that described a CTC procedure and then were asked about their willingness to undergo CTC and about other relevant factors, such as fees.

After being informed about CTC screening, 83 percent subjects stated that they would be willing to undergo a CTC study, Ho and colleagues reported. However, 70 percent stated that they would not be willing to pay out-of-pocket fees if insurance did not cover the study, and even among the 30 percent who were willing to pay the fees, the average amount they were willing to pay (mean, $244; median, $150) was well below currently charged rates.

Although these values could have been widely influenced by the relatively small size of the study, the authors wrote it is “interesting” to note that these values are consistent with the cost-effectiveness analysis by the Agency for Healthcare Research and Quality’s analysis performed for the Centers for Medicare & Medicaid Services, which found that CTC could become a cost-effective screening strategy when its cost was approximately $200 or less.

“Exploration into factors affecting patient adherence found that a procedure’s invasiveness and need for sedation were the most important,” Ho and colleagues concluded.