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ACR calls for virtual colonoscopy coverage

by Gus Iversen, Editor in Chief | August 29, 2014
Courtesy of ACR
CMS has announced plans to cover Cologuard — a colon cancer screening test for asymptomatic average risk beneficiaries aged 50 to 85 years. The American College of Radiology (ACR) has responded positively to the decision, and is asking CMS to extend that coverage to also include CT colonoscopy, (CTC, or virtual colonoscopy). In an open letter to CMS, Judy Lee, the chair of the ACR's colon cancer committee, concluded that the use of virtual colonoscopy meets, and may even exceed, the same evidence standard used to approve Cologuard coverage.

The letter indicates that although Cologuard stool DNA tests are twice as sensitive as the fecal immunochemical test (FIT) for detecting advanced adenoma — 42 percent versus 24 percent — the virtual colonoscopy can take accuracy of colorectal polyp detection up to 90 percent. Detecting adenomas can be useful in predicting high risk for colon cancer and prompting action to prevent cancer from developing. In terms of detecting colorectal cancer itself, Cologuard detects up to 92 percent while a virtual colonoscopy may detect up to 96 percent.

The letter also states that Cologuard provides less accurate results for women than it does for men. With virtual colonoscopy, the ACR says you do not see the same disparity.

Furthermore, the ACR says the comparatively high rate of false positives associated with Cologuard can lead to unnecessary patient anxiety, as well as unnecessary downstream expenses.

Citing compliance studies conducted at National Military Medical Centers in Bethesda, Md., and in San Diego, Calif., the ACR believes CMS can increase patient adherence rates by offering virtual colonoscopy coverage. That increase may limit the number of patients requiring optical colonoscopies — which are both more invasive and more expensive — to the ones most likely to actually require therapy.

DOTmed spoke to Shawn Farley, the director of public affairs for the ACR, about the cost comparison of Cologuard and a virtual colonoscopy. "Medicare would pay about $600 for the DNA test," said Farley. "Medicare does not currently pay for screening CTC. However, Medicare pays around $375 for a diagnostic CTC."

In terms of test frequency, asymptomatic seniors should have the Cologuard test administered every three years, whereas the virtual colonoscopy is recommended to be performed every five years. Over time that lesser frequency may translate to money saved.

In her letter, Yen also pointed out that virtual colonoscopy is the only colorectal cancer screening method that also provides extracolonic screening of the surrounding areas, which may be useful in detecting certain aneurysms, osteoporosis, and cancers outside of the colon. Yen also addresses the concern of low-dose radiation exposure with virtual colonoscopy by saying, "health effects in adults are either too small to measure or are non-existent."

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