Among insured individuals, out-of-pocket (OOP) costs for those who undergo colonoscopy following a noninvasive stool-based test (SBT) are common and increase when polypectomy is performed, according to a study published in JAMA Network Open.
The Patient Protection and Affordable Care Act requires that colorectal cancer screening methods, including colonoscopy and SBTs, be covered with no consumer cost sharing for patients at average risk for cancer that meet age-based eligibility requirements. However, follow-up colonoscopies after a positive SBT may result in OOP costs for patients, thereby presenting as a cost barrier for individuals who defer colorectal cancer screening; this may also create financial burdens for those who require follow-up care.
Researchers in the United States sought to describe OOP costs for colonoscopy within 6 months after a noninvasive SBT. They identified 80,951 patients (74,235 [91.7%] from a commercial claims database and 6716 [8.3%] from a Medicare claims database) who underwent a noninvasive SBT. In total, 12,823 (15.8%) underwent a subsequent colonoscopy within 6 months, and of these patients, 7416 (57.8%) had a polypectomy.
The researchers found that consumer cost sharing for colonoscopy following a noninvasive SBT were common; OOP costs of more than $0 in occurred in 48.2% of commercial claims and 77.9% of Medicare claims. OOP costs ranged from $99 to $231, depending on the type of original screening test (multitarget stool DNA, fecal immunochemical test, or fecal occult blood test). OOP costs were higher when polypectomy was performed.
This study was limited by a lack of data on the indications for performing a colonoscopy following an SBT. Additionally, the study cohort did not include uninsured patients, limiting its generalizability.
The authors concluded, “As noninvasive SBT screening modalities are preferred by some, and use of these modalities has increased during the COVID-19 pandemic (when colorectal cancer screening rates have declined), it is important for payer policies to cover all components of screening to avoid discouraging patients from completing the evaluation.”
Disclosure: This research was supported by a contract with Exact Sciences Corporation. Please see the original reference for a full list of disclosures.
Fendrick AM, Princic N, Miller-Wilson L-A, Wilson K, Limburg P. Out-of-pocket costs for colonoscopy after noninvasive colorectal cancer screening among US adults with commercial and Medicare insurance. JAMA Netw Open. 2021;4(12):e2136798. doi:10.1001/jamanetworkopen.2021.36798