JACR: CT colonography adoption inches up

Despite a lack of Medicare reimbursement, adoption of CT colonography (CTC) by U.S. hospitals increased from 13 percent in 2005 to 17 percent in 2008, according to a study published in this month's Journal of the American College of Radiology.

CTC is associated with a host of advantages and disadvantages. The minimally invasive procedure allows visualization of the entire colorectum, is less time-consuming than optical colonoscopy, avoids sedation and reduces the risk of colon perforation. However, it exposes patients to radiation and does not allow for polyp removal.

The American Cancer Society, American College of Radiology and U.S. Multi-Society Task Force on Colorectal Cancer have issued a joint guideline, recommending CTC screening every five years. The U.S. Preventive Services Task Force, however, does not recommend the procedure, citing insufficient evidence. And the Centers for Medicare & Medicaid Services (CMS) do not cover the procedure with the exception of specific indications, such as patients with failed optical colonoscopy.

Meanwhile, 50 to 60 percent of adults over the age of 50 years comply with colorectal screening. “Some studies of patient acceptance, preference and satisfaction suggest that many patients prefer CTC to optical colonoscopy, so it potentially represents an important option for increasing national screening rates,” wrote Megan McHugh, PhD, of Health Research and Educational Trust in Chicago.

McHugh and colleagues designed the study to estimate the extent of CTC at U.S. hospitals, assess availability of optical colonoscopy at hospitals that offer CTC and identify factors that hinder and promote CTC adoption. The researchers relied on data from the 2005 to 2008 American Hospital Association annual surveys, which comprised approximately 4,000 surveys yearly. In addition, they selected six hospitals that provide CTC and three that do not to participate in an exploratory telephone survey and discuss key issues in the decision-making process.

The researchers found that CTC adoption rose from 13 percent in 2005 to 17 percent in 2008. Respondents to the telephone survey listed several reasons for deploying CTC: an ability to provide an alternative to optical colonoscopy, long waits for optical colonoscopy and patient demand. One of the six respondents referred to low screening rates in the community as a motivator.

All respondents offering CTC noted the presence of a radiology advocate, and most cited support for the service among gastroenterologists. However, two of the six referred to “initial hesitation or lack of support for the service among gastroenterologists.”

Five of the six CTC sites primarily reserve the service for covered patients i.e. those with failed optical colonoscopy. At the other site, a higher volume facility that performed more than 1,000 studies annually, a radiologist convinced local insurers to cover CTC. All six sites make available same-day scheduling for CTC patients who require biopsies.

In contrast, the three sites that do not offer CTC decided not to implement the service because of the lack of reimbursement and deployment costs (which include a carbon dioxide insufflator and/or software at about $5,000 to $20,000).

The preliminary findings of “modest but growing” CT adoption offer some good news, suggested McHugh and colleagues. “The individuals we interviewed reported a relatively quick and easy implementation of the services.” Because programs tend to concentrate on patients who failed optical colonoscopy, competition among radiologists and gastroenterologists is minimal.

After noting that the survey offers baseline data but did not produce generalizable results, the authors offered that the radiology community is likely to continue to study factors related to the CMS’s negative reimbursement decision and to develop the technology.

“These data would be beneficial to public health researchers and policymakers as they consider strategies for increasing colorectal cancer screening rates and the role that CTC should play,” summed McCugh and colleagues.