ASPO Abstracts
A Real World Analysis of the Costs of Colonoscopy and Events Following Colonoscopy Among Average Risk Adults with Medicaid Insurance
Category: Early Detection & Risk Prediction
Conference Year: 2021
Abstract Body:
PURPOSE: This study examined costs of colonoscopy screening and events following colonoscopy among average risk adults with Medicaid insurance.
METHODS: Adults (ages 50-75 years) with colonoscopy screening between 1/1/2014-12/31/2018 (index = earliest test) were selected from the IBM MarketScan Multi-State Medicaid database. Individuals were required to have 10 years of continuous health plan enrollment prior to and 30 days following index date. Individuals at above average risk for CRC or with prior CRC screening were excluded. Costs of colonoscopy (total, plan paid, out-of-pocket) were measured +/-30 days of colonoscopy date (inclusive of procedure costs, pathology costs, anesthesia costs, and bowel preparation prescription costs). Events and their associated costs were assessed 30 days following the colonoscopy and were reported overall, by event type (serious gastrointestinal [GI], other GI, cardiovascular [CV]), and by individual event.
RESULTS: The study included 13,134 average risk adults with colonoscopy screening. Mean age was 59.3 years, 64.3% were female, 63.6% had Medicare dual eligibility, and the mean (SD) Deyo-Charlson comorbidity score was 1.9 (2.1). Overall, 32.3% had a bowel preparation prescription, 79.0% had anesthesia, and 63.3% had a pathology claim associated with their colonoscopy. Mean (SD) colonoscopy procedure costs for individuals with Medicaid were: total costs $684 ($907), plan paid $677 ($914), and out-of-pocket $6 ($132). A total of 10.9% had any incident event. Serious GI events were observed in 4.6% and 4.3% had other GI events and 3.0% had CV events. Mean (SD) all-cause total costs among individuals with any event following colonoscopy were $7,535 ($23,019) and ranged from $6,189 ($18,195) among those with a serious GI event to $12,750 ($30,046) among those with a CV event.
CONCLUSIONS: This study reports the costs associated with colonoscopy screening for individuals with Medicaid insurance. We were unable to assess causality of events and colonoscopy. However, we observed that the rate of comorbidities was high and may have contributed to the high number of events following colonoscopy and additional costs in this Medicaid-insured cohort.
Keywords: Medicaid, colorectal cancer screening, colonoscopy events