CMS rejects case for virtual colonoscopy reimbursement

Proponents of virtual colonoscopy (also known as CT colonography, or CTC) suffered a setback this week when the U.S. Centers for Medicare and Medicaid Services (CMS) issued a proposal rejecting federal reimbursement for VC screening for colorectal cancer.

"The evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test," CMS said in a statement published on February 11. "CT colonography for colorectal cancer screening remains noncovered."

CMS is requesting public comments on the proposal for the next 30 days, but it's unlikely the agency will reverse its position, especially given the negative reviews that VC received during a November 19 hearing examining the evidence in favor of reimbursement.

In that meeting, members of the Medicare Evidence Development and Coverage Advisory Committee (MedCAC) gave mostly mediocre scores to a series of questions regarding virtual colonoscopy's effectiveness on both a clinical and cost-effectiveness basis.

Some MedCAC panel members said that the benefits of finding and working up the extracolonic findings from virtual colonoscopy remain unproven, and that the associated costs and risks are poorly understood. Others stated that based on available evidence, screening with VC would not necessarily result in a cost savings, at least at current screening compliance rates that have hovered for years at less than 50% of eligible adults ages 50 and older.

CT colonography expert Dr. Perry Pickhardt, however, believes that the evidence is there to support federal reimbursement, and that the CMS announcement could have negative ramifications for patient care.

"This initial proposed decision memo is quite a surprise in the face of overwhelming evidence in favor of CTC for screening," Pickhardt said. "This proposed decision not only ignores the advantages of CTC, but also ignores the current status of colorectal cancer screening -- many people are dying from an easily preventable disease."

In fact, Pickhardt believes that VC is being held to a higher standard than the current standard of care, optical colonoscopy.

"Given [CTC's] advantages over optical colonoscopy in terms of clinical effectiveness, patient safety, and cost-effectiveness, perhaps [CMS] needs to reassess coverage for the previous 'gold standard' as well," Pickhardt said.

By Brian Casey staff writer
February 12, 2009

Related Reading

MedCAC panel gives VC mediocre marks, November 25, 2008

MedCAC panel members question VC's effectiveness, November 25, 2008

Gastroenterologists embrace VC screening, with caveats, October 28, 2008

CMS announces VC evidence meeting, September 26, 2008

ACR, others exhort CMS to cover virtual colonoscopy, June 19, 2008

Copyright © 2009

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