CMS has tentatively decided not to pay for virtual colonoscopies
13 02 09 - 13:04
Medicare Blow to Virtual Colonoscopies
By ANDREW POLLACK - The New York Times
Medicare has tentatively decided not to pay for virtual colonoscopies, dealing a setback to a technique that some medical experts recommend as a more tolerable alternative to conventional colonoscopy in screening for colon cancer.
The Centers for Medicare and Medicaid Services said in a decision posted on its Web site that there was “insufficient evidence” to conclude that virtual colonoscopy “improves outcomes in Medicare beneficiaries.”
The agency is taking public comments for 30 days before issuing a final decision.
Dr. Sean Tunis, a former chief medical officer for Medicare, said that there had been cases where a tentative coverage determination had been changed but that this one seemed to be “pretty carefully and fully considered.”
“I personally would be a little surprised if the final decision were different,” Dr. Tunis said.
Virtual colonoscopy, formally known as CT colonography, uses noninvasive CT scans, which depend on X-rays to get images of the inside of the colon for abnormal growths called polyps. Controversy has swirled for years over whether the CT scans were as effective as conventional colonoscopy, in which a probe with a camera on its end is snaked through the rectum and colon.
Supporters of CT scans denounced the decision.
“It seems to defy logic,” said Dr. Perry J. Pickhardt, associate professor of radiology at the University of Wisconsin, who has consulted for some makers of software used to analyze the CT scans.
Dr. Pickhardt said the virtual colonoscopy was “better, safer, faster, cheaper” than conventional colonoscopy.
Dr. Durado Brooks, director for colorectal and prostate cancer at the American Cancer Society, said the decision would reduce the choices available. “There are certainly some patients who may opt not to be screened because they don’t want to have a colonoscopy,” Dr. Brooks said.
The cancer society, in partnership with other groups, last year began recommending virtual colonoscopy as one option for colon cancer screening. But the United States Preventive Services Task Force, which advises the government on prevention, said last year that there was insufficient evidence to assess the benefits and harms of the CT technique. Some private insurers pay for the tests; others do not.
CT scans detect larger polyps about as well as colonoscopy, according to Medicare’s analysis. They are not as good at detecting smaller polyps, although there is debate over whether such smaller growths are dangerous.
The CT scans do not require the sedation often used for colonoscopies, and they have a lower risk of bowel perforations. But they still require unpleasant bowel preparation, and they do expose patients to radiation. If polyps are detected, a patient would typically undergo a regular colonoscopy to have them removed.
“Why do a test that will pretty much require another test to be done?” said Dr. John Petrini, president of the American Society for Gastrointestinal Endoscopy. The society, whose members perform conventional colonoscopies, supported Medicare’s decision.
In its analysis, Medicare said many studies supporting virtual colonoscopy were done in people with a mean age around 58, so results might not fully apply to Medicare’s older population.
For instance, older people are more likely to have polyps. So the proportion of people who would have to have a conventional colonoscopy after a virtual one would be greater. That would make the CT scan less cost-effective.