Deborah A. Fisher, MD, MHS1, Nicole Princic, MS2, Lesley-Ann Miller-Wilson, PhD, MBA3, Kathleen Wilson, MS2, Kathryn DeYoung, MS2, Mark Fendrick, MD4, Paul J. Limburg, MD, MPH5; 1Duke University, Durham, NC; 2IBM Watson Health, Cambridge, MA; 3Exact Sciences Corporation, Madison, WI; 4University of Michigan, Ann Arbor, MI; 5Mayo Clinic, Rochester, MN
Introduction: Screening is recommended for individuals aged 50-75 years at average risk for colorectal cancer (CRC). Although several non-invasive options are available, colonoscopy remains the most commonly used screening test. This study assessed costs of colonoscopy for patients at average risk for CRC in the US. Methods: The IBM MarketScan administrative claims databases were used to select adults (age ≥45-75 years) with a claim for CRC screening during 1/1/2014-6/30/2019 (index = earliest test). Patients were required to have 10 years of continuous health plan enrollment prior to and for 30 days following index. Patients at high-risk for CRC, with prior CRC screening (already up to date), < 50 years old at index, and with a CRC screening test other than colonoscopy on index were excluded. Subsets with and without a complication related to colonoscopy (defined as a new diagnosis for a gastrointestinal, cardiovascular, or cerebrovascular condition within 30 days of the colonoscopy) were identified. Costs of colonoscopy (total, plan paid, out of pocket) were measured during the +/-30 days from the colonoscopy date (inclusive of procedure costs, pathology costs, anesthesia costs, and bowel preparation prescription costs). Mean costs were reported overall, and for colonoscopies with and without complications. Results: The study population included 228,409 average risk patients with colonoscopy (9,381 [4.1%] with complications and 219,028 [95.9%] without complications). Mean age was 56.8 years, 49.8% were male, and the mean (standard deviation [SD]) Deyo-Charlson comorbidity score was 0.38 (SD 0.86). Overall, 47.6% had a bowel preparation prescription, 82.9% had anesthesia, and 60.4% had a pathology claim associated with their colonoscopy. Mean (SD) costs of colonoscopy among all patients were $2125 ($1369) and out of pocket costs comprised 3.7% of the total. Colonoscopy costs for patients with bowel preparation, anesthesia, and pathology were $2185 ($1397),$2228 ($1386), and $2367 ($1507) respectively (Figure 1). Colonoscopy costs were similar for patients with and without complications (mean $2,128 [SD $1,695] and mean $2,125 [SD $1,353]), but out of pocket costs were higher (with vs without complications; p < 0.001) (Table 1). Discussion: This study provides further clarity regarding the costs of colonoscopy based on comprehensive review of a robust claims dataset. These findings will better inform analyses and assessments of endorsed CRC screening options.
Figure 1: Colonoscopy Costs, Overall, With Bowel Preparation, With Anesthesia, with Pathology
Table 1: Colonoscopy Costs, Overall, With Complications and Without Complications
Disclosures: Deborah Fisher: Exact Sciences and Guardant Health – Consultant. Nicole Princic: IBM Watson Health – Employee. Lesley-Ann Miller-Wilson: Exact Sciences Corporation – Employee. Kathleen Wilson: IBM Watson Health – Employee. Kathryn DeYoung: IBM Watson Health – Employee. Mark Fendrick: AbbVie – Consultant. Agency for Healthcare Research and Quality – Grant/Research Support. Amgen – Consultant. Arnold Ventures – Grant/Research Support. Centers for Medicare and Medicaid Services – Grant/Research Support. Centivo – Consultant. Community Oncology Association – Consultant. Covered California – Consultant. EmblemHealth – Consultant. Exact Sciences Corporation – Consultant. Freedman Health – Consultant. Gary and Mary West Health Policy Center – Grant/Research Support. GRAIL – Consultant. Harvard University – Consultant. Health & Wellness Innovations – Consultant. Health at Scale Technologies – Consultant. MedZed – Consultant. National Pharmaceutical Council – Grant/Research Support. Patient-Centered Outcomes Research Institute – Grant/Research Support. Penguin Pay – Consultant. Pharmaceutical Research and Manufacturers of America – Grant/Research Support. Risalto – Consultant. Robert Wood Johnson Foundation – Grant/Research Support. Sempre Health – Consultant. State of Michigan – Grant/Research Support. State of Minnesota – Consultant. U.S. Department of Defense – Consultant. Virginia Center for Health Innovation – Consultant. Wellth – Consultant. Zansors – Consultant. Paul Limburg: Exact Sciences Corporation – Other Financial or Material Support, serves as Chief Medical Officer for Screening at Exact Sciences through a contracted services agreement with Mayo Clinic. Dr. Limburg and Mayo Clinic have contractual rights to receive royalties through this agreement..