From the Journals

Waiving Medicare coinsurance for positive colorectal screening likely beneficial


 

FROM HEALTH AFFAIRS

Waiving coinsurance for Medicare beneficiaries who have a screening colonoscopy when it results in a polyp removal or follows a positive fecal screening test would likely have a favorable balance of health and cost impact.

Currently, Medicare covers colorectal screening at no charge to the patient, but if a polyp is removed upon discovery during the procedure, the patient would then be subject to Medicare’s coinsurance payments for both the colonoscopy and the removal.

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“We estimated that waiving coinsurance would be cost-effective if screening rates increased from 60.0% to 60.6%, assuming a willingness-to-pay threshold of $50,000 per QALY [quality-adjusted life-year] gained – which suggests that the waiver would likely have a very favorable balance of health and cost impact,” Elisabeth F.P. Peterse, of Erasmus University Medical Center, Rotterdam, The Netherlands, and her colleagues wrote in new research appearing in the December 2017 issue of Health Affairs.

Researchers used the Microsimulation Screening Analysis-Colon model to estimate the cost-effectiveness of waiving coinsurance for every component of colorectal cancer screening. They estimated that, currently, using the colonoscopy regimen with coinsurance, 12.8 colorectal cancer deaths occurred per 1,000 people aged 65 years and 124.1 QALYs were gained per 1,000 people aged 65 years. The total number of procedures per 1,000 Medicare beneficiaries was 1,132, of which 410 (36%) were potentially subject to coinsurance requirements.

“We estimated that the total lifetime costs for [the Centers for Medicare & Medicaid], which included colorectal cancer screening, surveillance, and treatment with coinsurance, to be $2.675 million per 1,000 sixty-five-year-olds,” Ms. Peterse and her colleagues wrote.

Researchers noted that if the coinsurance was waived but there was no follow-on increase in the screening rate, the benefits of screening would not change but the total cost of screening and treatment would increase to $2.726 million per 1,000 people aged 65 years.

However, “an assumed 5-percentage-point increase in the rates of first colonoscopy screening and surveillance decreased the number of colorectal cancer deaths by 0.9 (6.4 percent), accompanied by an increase of $33,000 (1.2 percent) in total costs, with a cost per QALY gained (or cost-effectiveness ratio) of $4,086.”

They added that estimated screening benefits were similar when fecal testing was the primary screening method.

“In general, [fecal testing] screening was associated with lower number of procedures subject to coinsurance,” the researchers added. “If [fecal testing] screening becomes more popular in the United States, following trends observed in several settings, the costs of waiving coinsurance would be even lower.” The researchers also suggest that it could lead to reducing disparities of colorectal cancer in the United States as well.

AGA has been working for years to try to fix this issue, and supports the bipartisan Removing Barriers to Screening Act, which would correct this inequity for Medicare beneficiaries and remove the financial barriers that may prevent a patient from undergoing a screening. AGA is hopeful that the growing support for the legislation on both sides of the aisle will help get the bill passed this year. To learn more about this issue, visit http://www.gastro.org/take-action/top-issues/patient-cost-sharing-for-screening-colonoscopy. To help your patient understand this issue, AGA has created “What to Expect: Paying for Your Colonoscopy,” which can be downloaded at http://www.gastro.org/patient-care/procedures/Colonoscopy_CoPay_WhatToKnowFactSheet.pdf to be shared in your office. /p>

SOURCE: Peterse EFP et al. Health Affairs. 2017 Dec;36(12):2151-9.

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