Report from VCS: Rosy virtual colonoscopy prediction presages higher screening costs

Virtual colonoscopy is likely to perform well in the American College of Radiology Imaging Network Trial, but the result could be a $2 billion boost in national colon cancer screening costs, according to a presentation Monday at the Sixth Annual Virtual Colonoscopy Symposium in Boston.

Dr. Jay Heiken, director of abdominal imaging at Washington University in St. Louis, predicted that when the ACRIN 6664 National CT Colonoscopy Trial is completed, virtual colonoscopy will have achieved a sensitivity of between 75% and 85% for polyps greater than 10 mm.

"Given such results, we will be able to establish virtual colonoscopy as a legitimate screening test for colorectal cancer," Heiken said.

With a goal of 2300 to 2600 participants, the ACRIN 6664 trial now has 15 institutions on board and is expected to report results within a year, said Dr. C. Daniel Johnson, a professor of radiology at the Mayo Clinic in Rochester, MN.

If virtual colonoscopy achieves good results, public demand for the test would increase, but the mood of third-party payers could be panic, Heiken said.

He gave a rough economic analysis based on allowable reimbursement by Medicare in Missouri predicting what would happen if virtual colonoscopy were added to the colon cancer screening roster. He cited the costs of the various screening methods:

• fecal occult blood test: $22

• flexible sigmoidoscopy, office: $121

• air contrast barium enema: $135

• optical colonoscopy: $671

• virtual colonoscopy, estimated: $553

Broken down to a yearly cost per patient, costs could range from $46 for the fecal occult blood test to $111 for virtual colonoscopy, according to Heiken.

If half of patients switch from an alternative screening method to virtual colonoscopy and patient compliance does not improve, annual screening costs would increase by $700 million, Heiken said. If another 25% of those who would never have gotten screened decide to undergo virtual colonoscopy, the costs would increase by $1.5 billion. If the compliance percentage jumps to 50%, the costs would move up to $2 billion.

This analysis did not include ancillary costs, including follow-up interventions, which could increase these totals further, Heiken said. Ideally, a more comprehensive analysis would also include potential savings introduced by moving to virtual colonoscopy screening. These could be significant considering the astronomical costs of treating patients who have cancer.

For more information from the online Diagnostic Imaging archives:

CT colonography screening trial seeks definitive answers

Large CT colonography trial opens with mixed reactions

CT colonography standards foster exam's legitimacy