Despite the absence of Medicare coverage, hospital use of computed tomographic colonography (CTC), commonly referred to as virtual colonoscopy, is on the rise, according to a study in the March issue of the Journal of the American College of Radiology. Colorectal cancer is the second leading cause of cancer deaths in the U.S. CTC, a minimally invasive alternative to optical colonoscopy for colorectal cancer screening, employs virtual reality technology to produce a 3-D visualization that permits a thorough evaluation of the entire colon and rectum.
Data on the provision of colorectal cancer screening services by nonfederal, general hospitals were analyzed using the 2005 to 2008 American Hospital Association annual surveys. In addition, in 2009, exploratory interviews were conducted with representatives from radiology departments at nine hospitals; six that provided CTC and three that did not. Researchers found that in 2008, 17 percent of hospitals offered CTC, up from 13 percent in 2005. Sixty-nine percent of hospitals that offered CTC in 2008 also offered optical colonoscopy services. Factors motivating the adoption of CTC included a desire to provide an alternative screening option for frail, elderly patients and patients with failed optical colonoscopy; long waits for optical colonoscopy; and promising evidence on CTC published in peer-reviewed literature. Lack of reimbursement was a commonly cited barrier.
"Our study is unique in that we show expansion even in the absence of Medicare reimbursement for CTC for general screening. CTC's relatively easy implementation coupled with patient acceptance makes CTC a tool that holds promise for the future of colorectal cancer prevention," said Megan McHugh, PhD, lead author of the study.
CTC is proven in clinical trials to be as accurate as standard colonoscopy at detecting clinically significant lesions in average risk patients and is endorsed by the American Cancer Society as a recommended colon cancer screening test. Yet, Medicare does not cover seniors for CTC. As policymakers and others consider ways to increase colorectal cancer screening, it is important to understand US hospitals' readiness to offer CTC and the factors that facilitate or impede adoption.
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More information: www.jacr.org