Costs of colorectal cancer screening with colonoscopy, including post-endoscopy events, among adults with Medicaid insurance

Abstract

Objective

To examine the healthcare utilization and costs associated with colorectal cancer (CRC) screening by colonoscopy, including costs associated with post-endoscopy events, among average-risk adults covered by Medicaid insurance.

Methods

This cohort study evaluated a population of adults (ages 50–75 years) with CRC screening between 1/1/2014 and 12/31/2018 (index = earliest test) from the IBM MarketScan Multi-State Medicaid database. Individuals at above-average risk for CRC or with prior CRC screening were excluded. CRC screening was reported by screening type: colonoscopy, fecal immunochemical test [FIT], fecal occult blood test [FOBT], multi-target stool DNA [mt-sDNA]. Frequency and costs of events potentially related to colonoscopy (defined as occurring within 30 days post-endoscopy) were reported overall, by event type, and by individual event.

Results

We identified a total of 13,134 average-risk adults covered by Medicaid insurance who received screening by colonoscopy; 63.6% (8350) had Medicare dual-eligibility while 36.4% (4785) did not have Medicare dual-eligibility. The mean (SD) cost of a colonoscopy procedure was $684 ($907) and mean (SD) out-of-pocket costs were $6 ($132). Serious gastrointestinal (GI) events (perforation and bleeding) were observed in 4.6% of individuals with colonoscopy, 4.3% had other GI events, and 3.0% had an incident cardiovascular/cerebrovascular event. Mean (SD) event-related costs were $1233 ($5784) among individuals with a serious GI event, $747 ($1961) among individuals with other GI events, and $4398 ($19,369) among individuals with a cardiovascular/cerebrovascular event.

Conclusions

This large, claims-based cohort study reports average (SD) out-of-pocket costs for Medicaid beneficiaries at $6 ($132), which could be one factor contributing to the accessibility of CRC screening by colonoscopy. The incidence of events potentially associated with colonoscopy (i.e. within 30 days after the screening) was 3–4%, and the event-related costs were considerable.

Keywords:

• Colorectal neoplasms
• prevention & control
• mass screening
• statistics & numerical data
• colonoscopy
• statistics & numerical data

Transparency

Declaration of funding

This study was funded by Exact Sciences Corporation.

Declaration of financial/other relationships

NP and KW are employed by IBM Watson Health which received funding from Exact Sciences Corporation to conduct this study. DAF is a consultant for Exact Sciences and Guardant Health. LM is an employee of Exact Sciences Corporation. PL serves as Chief Medical Officer for Screening at Exact Sciences through a contracted services agreement with Mayo Clinic. PL and Mayo Clinic have contractual rights to receive royalties through this agreement.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors were involved in study design, analysis, and interpretation of the data, drafting and revising the paper and approving the final version of the manuscript. All authors agree to be accountable for all aspects of the work.

Acknowledgements

Medical Writing services were provided by Jessamine Winer-Jones, Ph.D. of IBM Watson Health. Programming services were provided by Steven Gelwicks of IBM Watson Health. Analytic services were provided by Kathryn DeYoung of IBM Watson Health at the time the analysis was conducted.

Ethics approval and informed consent

All database records are statistically de-identified and certified to be fully compliant with US patient confidentiality requirements set forth in the Health Insurance Portability and Accountability Act of 1996. Because this study used only de-identified patient records and did not involve the collection, use, or transmittal of individually identifiable data, this study was exempted from Institutional Review Board approval.

Data availability statement

The data that support the findings of this study are available from IBM Watson Health. Restrictions apply to the availability of these data, which were used under license for this study.