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

Figures & data

Figure 1. Cohort Selection. ¹CRC screening tests were mt-sDNA, colonoscopy, fecal immunochemical testing (FIT), fecal occult blood testing (FOBT), sigmoidoscopy, CT colonography and double-contrast barium enema (DCBE). ²FIT or FOBT in the year prior to the index date, no evidence of mt-sDNA test in 3 years prior to the index date, no evidence of other screening (sigmoidoscopy, CT colonography or DCBE) in 5 years prior to the index date, and no evidence of colonoscopy in 10 years prior to the index date. ³Codes and conditions for identifying above average-risk adults can be found in Supplementary Table 1.

Table 1. Patient characteristics of average-risk adults with screening colonoscopy covered by Medicaid insurance.

	Colonoscopy (N = 13,134)		Colonoscopy with Medicare dual eligibility (N = 8350)		Colonoscopy without Medicare dual eligibility (N = 4784)		p-value (with vs. without)
Age (Mean, SD)	59.3	7.2	61.1	7.7	56.3	5.0	<.001
Age category (N, %)							<.001
50–54	4397	33.5%	2292	27.4%	2105	44.0%
55–59	2796	21.3%	1491	17.9%	1305	27.3%
60–64	2610	19.9%	1431	17.1%	1179	24.6%
65–69	1805	13.7%	1668	20.0%	137	2.9%
70–75	1526	11.6%	1468	17.6%	58	1.2%
Female (N, %)	8441	64.3%	5135	61.5%	3306	69.1%	<.001
Race (N, %)							<.001
White	6290	47.9%	4415	52.9%	1875	39.2%
Black	5470	41.6%	3174	38.0%	2296	48.0%
Hispanic	84	0.6%	51	0.6%	33	0.7%
Native Hawaiian or Other Pacific Islands	62	0.5%	33	0.4%	29	0.6%
American Indian or Alaska Native	43	0.3%	24	0.3%	19	0.4%
Two or more races/Other/Unknown	1185	9.0%	653	7.8%	532	11.1%
Deyo-Charlson Comorbidity Index (Mean, SD)	1.9	2.1	1.9	2.1	1.8	2.1	.732
DCI Comorbid Components (N, %)
Diabetes (mild to moderate)	4886	37.2%	3163	37.9%	1723	36.0%	.033
Chronic pulmonary disease	4092	31.2%	2480	29.7%	1612	33.7%	<.001
Diabetes with chronic complications	1851	14.1%	1212	14.5%	639	13.4%	.066
Renal disease	1312	10.0%	936	11.2%	376	7.9%	<.001
Congestive heart failure	1161	8.8%	814	9.7%	347	7.3%	<.001
Cerebrovascular disease	1155	8.8%	764	9.1%	391	8.2%	.057
Peripheral vascular disease	822	6.3%	576	6.9%	246	5.1%	<.001
Malignancy	782	6.0%	507	6.1%	275	5.7%	.451
Rheumatologic disease	493	3.8%	294	3.5%	199	4.2%	.064
Myocardial infarction	422	3.2%	261	3.1%	161	3.4%	.454
Human immunodeficiency virus (HIV)	292	2.2%	142	1.7%	150	3.1%	<.001
Dementia	267	2.0%	199	2.4%	68	1.4%	<.001
Mild liver disease	221	1.7%	114	1.4%	107	2.2%	<.001
Hemiplegia or paraplegia	216	1.6%	135	1.6%	81	1.7%	.741
Peptic ulcer disease	176	1.3%	104	1.2%	72	1.5%	.213
Metastatic solid tumor	73	0.6%	40	0.5%	33	0.7%	.118
Moderate or severe liver disease	61	0.5%	35	0.4%	26	0.5%	.313

Abbreviation. SD, standard deviation.

Table 2. Utilization and costs associated with screening colonoscopy in the 30 days prior to and following colonoscopy among average-risk adults covered by Medicaid insurance.

	Colonoscopy (N = 13,134)		Colonoscopy with Medicare dual eligibility^c (N = 8350)		Colonoscopy without Medicare dual eligibility (N = 4784)		p-value (with vs. without)
Colonoscopy-related utilization
All bowel preparation prescriptions (N, %)	4248	32.3%	1522	18.2%	2726	57.0%	<.001
Anesthesiology claims (N, %)	10,372	79.0%	6248	74.8%	4124	86.2%	<.001
Pathology claims (N, %)	8314	63.3%	5509	66.0%	2805	58.6%	<.001
Colonoscopy-related costs among all patients
Total cost (Mean, SD)	$684	$907	$518	$881	$973	$879	<.001
Median	$405		$219		$818
Health plan paid^a (Mean, SD)	$677	$914	$516	$882	$960	$902	<.001
Median	$401		$218		$813
Out of pocket cost^a^,b (Mean, SD)	$6	$132	$2	$38	$13	$212	<.001
Median	$0		$0		$1

Abbreviations. CE, continuous enrollment; SD, standard deviation.

^aIndividuals who did not have the service contributed a $0 cost to the calculation.

^bIncluded copays, deductibles, and coinsurance.

^cMedicare pays first for the Medicare-covered services that are also covered by Medicaid; therefore, costs among individuals with dual eligibility with Medicare may be underreported.

Table 3. Gastrointestinal (GI) and cardiovascular/cerebrovascular (CV) events and costs associated with events^a in the 30 days following colonoscopy among average-risk adults covered by Medicaid insurance.

	Colonoscopy (N = 13,134)		Colonoscopy with Medicare dual eligibility^c (N = 8350)		Colonoscopy without Medicare dual eligibility (N = 4784)		p-value (with vs. without)
Patients with any serious GI events (N, %)	601	4.6%	492	5.9%	109	2.3%	<.001
All-cause total costs among patients with a serious GI event (Mean, SD)	$6189	$18,195	$4372	$14,401	$14,176	$27,838	<.001
Median	$1761		$1206		$4001
Event-related costs among patients with a serious GI event (Mean, SD)	$1233	$5784	$691	$1520	$3478	$12,790	<.001
Median	$225		$165		$689
Patients with GI bleeding (N, %)	590	4.5%	486	5.8%	104	2.2%	<.001
All-cause total costs among patients with the event (Mean, SD)	$5745	$17,568	$4371	$14,481	$12,014	$26,242	<.001
Median	$1740		$1203		$3780
Event-related costs among patients with the event (Mean, SD)	$958	$3936	$695	$1529	$2019	$8577	.002
Median	$223		$165		$649
Patients with GI perforation^b (N, %)	12	0.09%	7	0.08%	5	0.10%	.706
Patients with any other GI events (N, %)	566	4.3%	377	4.5%	189	4.0%	.125
All-cause total costs among patients with an other GI event (Mean, SD)	$7196	$24,949	$4929	$12,723	$12,081	$38,886	.001
Median	$2667		$1593		$4106
Event-related costs among patients with an other GI event (Mean, SD)	$747	$1961	$523	$1539	$1079	$2470	.001
Median	$164		$103		$303
Patients with any CV events (N, %)	396	3.0%	272	3.3%	124	2.6%	.032
All-cause total costs among patients with any CV (Mean, SD)	$12,750	$30,046	$9658	$26,884	$17,582	$33,632	.013
Median	$3075		$2006		$6209
Event-related total costs among patients with any CV event (Mean, SD)	$4398	$19,369	$3656	$16,328	$5282	$23,550	.427
Median	$134		$71		$284
Patients with any GI or CV event (N, %)	1426	10.9%	1040	12.5%	386	8.1%	<.001
All-cause total costs among patients with any event (Mean, SD)	$7535	$23,019	$5384	$16,569	$12,934	$33,849	<.001
Median	$2282		$1493		$4293
Event-related costs among patients with any event (Mean, SD)	$2023	$11,087	$1472	$8613	$3204	$15,320	.007
Median	$196		$132		$432

Abbreviation. SD, standard deviation.

^aCost of services are based on patients with at least one of the service in question; patients who did not have the service were not included in the calculation.

^bAll-cause and event-related total costs were not reported among patients with events below the minimum sample size (N ≤ 30) that would produce a clinically meaningful cost estimate.

^cMedicare pays first for the Medicare-covered services that are also covered by Medicaid; therefore, costs among individuals with dual eligibility with Medicare may be underreported.

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.