S0577 Healthcare Costs of Colonoscopy With and Without Complications Among Patients at Average Risk for Colorectal Cancer in the United States (US)

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INTRODUCTION: Screening is recommended for individuals aged 50-75 years at average risk for colorectal cancer (CRC). Although several non-invasive options are available, colonoscopy remains the most commonly used screening test. This study assessed costs of colonoscopy for patients at average risk for CRC in the US. METHODS: The IBM MarketScan administrative claims databases were used to select adults (age ≥45–75 years) with a claim for CRC screening during 1/1/2014-6/30/2019 (index = earliest test). Patients were required to have 10 years of continuous health plan enrollment prior to and for 30 days following index. Patients at high-risk for CRC, with prior CRC screening (already up to date), < 50 years old at index, and with a CRC screening test other than colonoscopy on index were excluded. Subsets with and without a complication related to colonoscopy (defined as a new diagnosis for a gastrointestinal, cardiovascular, or cerebrovascular condition within 30 days of the colonoscopy) were identified. Costs of colonoscopy (total, plan paid, out of pocket) were measured during the ±30 days from the colonoscopy date (inclusive of procedure costs, pathology costs, anesthesia costs, and bowel preparation prescription costs). Mean costs were reported overall, and for colonoscopies with and without complications. RESULTS: The study population included 228,409 average risk patients with colonoscopy (9,381 [4.1%] with complications and 219,028 [95.9%] without complications). Mean age was 56.8 years, 49.8% were male, and the mean (standard deviation [SD]) Deyo-Charlson comorbidity score was 0.38 (SD 0.86). Overall, 47.6% had a bowel preparation prescription, 82.9% had anesthesia, and 60.4% had a pathology claim associated with their colonoscopy. Mean (SD) costs of colonoscopy among all patients were $2125 ($1369) and out of pocket costs comprised 3.7% of the total. Colonoscopy costs for patients with bowel preparation, anesthesia, and pathology were $2185 ($1397), $2228 ($1386), and $2367 ($1507) respectively (Figure 1). Colonoscopy costs were similar for patients with and without complications (mean $2,128 [SD $1,695] and mean $2,125 [SD $1,353]), but out of pocket costs were higher (with vs without complications; P < 0.001) (Table 1). CONCLUSION: This study provides further clarity regarding the costs of colonoscopy based on comprehensive review of a robust claims dataset. These findings will better inform analyses and assessments of endorsed CRC screening options.Figure 1.: Colonoscopy Costs, Overall, With Bowel Preparation, With Anesthesia, with Pathology.Table 1.: Colonoscopy Costs, Overall, With Complications and Without Complications *Serious gastrointestinal (perforation and bleeding), other gastrointestinal (paralytic ileus, nausea/vomiting/dehydration, abdominal pain), cardiovascular/cerebrovascular (myocardial infarction/angina, arrythmia, heart failure, cardiac/respiratory arrest, syncope/hypotension/shock, stroke, transient ischemic attack)