Why are CT colonography use rates trending downward?

2017 11 15 21 16 4926 Colon Intestine 400

Patient awareness and use of CT colonoscopy have continued to dwindle since the start of the decade, whereas the opposite has been true for traditional optical colonoscopy, according to an article published online March 15 in the Journal of the American College of Radiology.

Numerous medical societies -- including the American Cancer Society, the American College of Radiology (ACR), and the U.S. Preventive Services Task Force (USPSTF) -- have, in recent years, recommended the use of CT colonography (CTC) as a screening test for colorectal cancer. These recommendations have prompted the five largest private insurance payors in the U.S. to offer reimbursement and coverage for CTC.

Despite such widespread endorsement, the U.S. Centers for Medicare and Medicaid Services (CMS) continues to withhold payment for the use of CTC in cancer screening.

In the current study, researchers from Massachusetts General Hospital, led by first author Dr. Anand Narayan, PhD, sought to understand how recent events may have affected recent trends in the utilization of CTC. They began by examining data from the National Health Interview Survey, which included the responses of 8,965 individuals living in the U.S. in 2010 and the responses of 12,721 individuals in 2015.

Their evaluation revealed statistically significant declines in overall patient awareness of the existence of CTC, from 20.5% in 2010 to 15.9% in 2015 (p < 0.001), as well as in the proportion of eligible individuals who underwent a CTC exam in 2015 compared with in 2010. In contrast, the proportion of individuals who had a traditional colonoscopy increased by a statistically significant degree from 2010 to 2015.

Trends for CT colonography utilization from 2010 to 2015
  2010 2015
Colonoscopy CTC Colonoscopy CTC
Usage rate 57.9% 1.2% 63.6% 0.9%
The differences were statistically significant (CTC: p = 0.014; colonoscopy: p < 0.001).

The researchers also performed a comprehensive analysis, combining data from 2010 and 2015, and identified factors that were associated with an increased awareness of CTC: having a higher income, being a woman, and being white. Previous studies have also shown that expanding access to insurance coverage led to significant increases in CTC usage rates while also increasing colonoscopy rates.

Radiologists are faced with the opportunity to play a key role in improving colorectal cancer screening, including by pushing for more extensive health insurance coverage for CTC, the authors noted.

"With active champions from local radiology practices, radiologists can help to establish high-volume centers of excellence for CT colonography screening. ... [CTC] may represent a potential pathway by which providers can reduce colorectal cancer disparities," they concluded.

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