Dr. Adam Kaye from the Hospital of the University of Pennsylvania assessed patients' willingness to pay for CTC (also known as virtual colonoscopy) versus optical colonoscopy -- by querying radiologists themselves about which procedure they would prefer.
"CT colonography has received mixed reviews in both radiology literature and clinical practice," Kaye said. "Radiologists themselves can be hesitant to incorporate it into their practice, given the time-intensive nature of its interpretation. However, there's a lack of information regarding patient preference with regard to CTC."
Optical colonoscopy requires bowel prep and sedation, and it's invasive; CTC doesn't require sedation and there's much less recovery time, Kaye said. CTC is covered by some private insurers, but not by Medicare: It received a grade "I" from the U.S. Preventive Services Task Force (USPSTF), which means the task force believes there's insufficient evidence to support reimbursement.
Kaye and colleagues sent a survey to 42 radiologists, presenting two scenarios. One involved receiving an optical colonoscopy that would be fully covered by insurance, while the other involved a CTC scan that would not be covered and, depending on the results, could require a follow-up colonoscopy anyway.
In total, 67% of respondents said they would prefer optical colonoscopy to CTC, Kaye's team found. One-third said they would pay for CTC if it cost less than $250; the mean amount patients were willing to pay was $215. Four respondents said they would prefer CTC only if it had 100% sensitivity; 16 said they would prefer CTC if it was 100% specific.
"Overwhelmingly, the most common reason survey participants gave for preferring an optical colonoscopy to CTC is that optical colonoscopy results are definitive," he said.
So where does this leave CTC, if even radiologists can't be convinced to undergo the exam? Radiologists need to educate their patients, according to Kaye.
"We need to present patients with the benefits of CTC," he said. "Maybe the convenience of the test is more important than its sensitivity and specificity."
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