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Medicare Probably Won't Cover Virtual Colonoscopy

by Lynn Shapiro, Writer | February 18, 2009
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The Centers for Medicare and Medicaid Services said in a decision posted on its website that there was insufficient evidence to conclude that virtual colonoscopy (CT colonography) improves outcomes in Medicare patients. The agency is taking public comments for 30 days before issuing a final decision.

Dr. Sean Tunis, a former chief medical officer for Medicare, said that there had been cases where a tentative coverage determination had been
changed but that this one seemed to be pretty carefully and fully considered.

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The United States Preventive Services Task Force, which advises the government on prevention, said last year that there was insufficient evidence to assess the benefits and harms of the CT technique. Some private insurers pay for the tests; others do not.

Medicare also said many studies supporting virtual colonoscopy were conducted in people with a mean age around 58, so results might not apply to Medicare's older population. For instance, older people are more likely to have polyps. So the proportion of people who would have to have a conventional colonoscopy after a virtual one would be greater. That would make the CT scan less cost-effective.

Opposing the Medicare decision, the American Cancer Society last year began recommending virtual colonoscopy as an option for colon cancer screening. According to an article published in the June 1, 2007 issue of CANCER, the society's journal, "targeting smaller (5 mm or less) lesions does little to significantly reduce the incidence of colorectal cancer and, in fact, results in extremely high financial costs and a large proportion of adverse events.

"A cost-benefit analysis study says the low malignancy rate among so-called diminutive polyps gives virtual colonoscopy with removal of lesions 6 mm or greater the best estimated value per life year gained and with fewer complications," the authors write.

"Effective screening through increased use of any of several available tests is the key to reducing deaths from colorectal cancer, the third most common cause of cancer death among both men and women in the United States. Despite the availability of effective screening tests, screening rates remain low and colon cancer deaths remain high."

The report goes on to say that "optical colonoscopy (OC) and flexible sigmoidscopy (FS), have been the primary screening tools for the last few decades but are associated with complications, from abdominal pain to life-threatening bowel perforation and bleeding. Virtual colonoscopy, or CT colonography (CTC), has arisen as a potentially effective CRC screening tool.