Rates of Incomplete and Repeat Screens in Patients Receiving Sodium Picosulfate/Magnesium Citrate Bowel Preparation Prior to Colonoscopy versus Other Low Volume Bowel Preparations

Abstract

Introduction: A successful colorectal cancer (CRC) colonoscopy screening depends on adequate bowel preparation. Patients may have difficulty tolerating high volume bowel preparations, increasing risk for incomplete screens and the need for early repeat screens. Low volume (LV) agents are generally better tolerated and require consumption of less solution. Sodium picosulfate/magnesium citrate (P/MC) is a LV bowel-preparation that requires patients to consume 10-oz of solution, followed by additional clear liquids. This retrospective study analyzed health insurance claims data from the Truven Health MarketScan® database for CRC colonoscopy screening for patients using prescribed LV bowel preparations during the 3-year period of July 1, 2012, to June 30, 2015. Methods: Claims data for CRC colonoscopy screening were analyzed to assess rates of incomplete screens and adverse events (AEs) with P/MC and other LV agents. Patients were aged ≥ 18 years, at average risk for CRC, with at least one claim for screening colonoscopy, and observable for 6 months pre-screening and 3 months post-screening. Logistic regression was used to calculate the odds of incomplete screens, repeat screens, and non-CRC hospitalizations, controlling for age, sex, illness burden (Charlson Comorbidities Index), specific comorbidities, and medication use. Results: Of 900,159 total screens using prescribed LV agents, 75,240 (8.4%) used P/MC and 824,919 (91.6%) used other agents. The observed rate of incomplete screens was lowest with P/MC (0.73%) versus all other LV agents as a class (0.94%), and versus the most commonly prescribed agents, Oral Sulfate Solution (OSS; 0.89%), and polyethylene glycol electrolyte solution with ascorbic acid (2L PEG-EA; 1.04%) (Table). OSS had significantly higher odds for an incomplete screen versus P/MC (Odds Ratio: 1.231; PPP< 0.001, all comparisons) for P/MC (11.2/1,000), versus all other LV agents (13.4/1,000), OSS (12.7/1,000) and 2L PEG-EA (13.8/1,000).Table: Table. Rates of Incomplete Screens With P/MC and Other Low Volume Bowel PreparationsConclusion: P/MC had lower odds for incomplete screens versus all other LV agents, higher odds for returning for re-screen following an incomplete screen, and lower odds of non-CRC hospitalization following screening.