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Open Access Research article

Costs and repeat rates associated with colonoscopy observed in medical claims for commercial and Medicare populations

Bruce Pyenson*, Charles Scammell and Jonah Broulette

Author Affiliations

Milliman, Inc., One Pennsylvania Plaza, 38th floor, New York, NY 10119, USA

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BMC Health Services Research 2014, 14:92  doi:10.1186/1472-6963-14-92

Published: 26 February 2014

Abstract

Background

Colorectal cancer is among the leading causes of cancer and cancer-related mortality in the United States. The incidence and mortality associated with CRC can be reduced with preventive screening. Inadequate bowel preparation has been associated with missed adenomas and the need for repeat colonoscopies.

Methods

Separate claims source databases were analyzed to determine the costs associated with colonoscopy in the commercial and Medicare populations. Observed repeat rates for colonoscopy within 4 years of initial screening were also examined.

Results

Among the 6 most commonly used billing codes, the average allowed cost for an episode of colonoscopy in 2010 was $2,146 in the commercial population and $1,071 in the Medicare population, with average cost sharing of $334 and $275, respectively. The portion of colonoscopies associated with a biopsy or polyp removal exceeded 50% in the commercial and Medicare populations. Approximately 57% of colonoscopies in the commercial population were associated with claims for a prescription bowel preparation product within 30 days prior to the procedure. Three branded and three generic bowel cleansing products accounted for approximately 75% of the total number of prescription claims for colonoscopy. Given literature reports that up to 25% of patients receive inadequate bowel preparation, the rate of repeat colonoscopy within 4 years of initial screening was lower than expected among patients who were not coded with common clinical reasons for early repeat: benign neoplasm, lesion, or polyp removed at initial screening colonoscopy.

Conclusions

The reported rates of inadequate bowel preparation are 15% to 25%, but the rates of repeat colonoscopy found in our analysis are much lower; this is a risk concern considering the reported, significant miss rate of adenomas secondary to inadequate bowel preparation.

Keywords:
Colonoscopy; Bowel preparation; Actuarial analysis; Colorectal cancer screening; Claims data