In an editorial in the February issue of the Journal of the American College of Radiology, two radiologists from the University of Arizona School of Medicine have called the decision of the Centers for Medicare and Medicaid Services not to reimburse CT colonography (CTC) “misguided and shortsighted.”
The authors, Arnold C. Friedman, MD, and Peter Lance, MD, were particularly critical of the agency’s argument that studies cited in support of coverage included small numbers of Medicare-aged patients and that there were no studies analyzing the technology in the elderly or groups over the age of 65.
Friedman and Lance argued that “there is nothing in the literature that we are aware of to suggest any relative difference in the efficacy of the only two viable whole colon screening examinations, optical colonoscopy and CTC, between the two age groups.”
The two radiologists also wrote that there is a fundamental methodological problem with the CMS stance. Pointing out that the universally accepted guidelines suggest that individuals at risk for colorectal cancer should be screened from the age of 50, Friedman and Lance asked whether “CMS is recommending contravention of this recommendation to recruit a study population that has reached the age of 65 without prior screening?”
They went on to argue that the diagnostic yield from such a study of an older age group that has been screened from the age of 50 will be “much smaller” than in a group that hasn’t been screened. “On which data set will the CMS place greater emphasis?" they asked.
Friedman and Lance referred to data that shows that just over 50 percent of adults over the age of 50 are considered to be appropriately screened and that the rest have chosen not to undergo optical colonoscopy for one reason or another. They proceeded to say that CTC is an effective alternative that many of those screening candidates would accept if it was reimbursed.
"Medicare coverage for CTC will facilitate colorectal cancer screening in the Medicaid population, save lives, and over the long term reduce Medicare expenditures,” wrote the two radiologists, who concluded with the warning—“Pay me now or pay me later.”