Sa1020 Association of Use of Anesthesia Services During Colonoscopies and Colorectal Cancer Screening Rates

Abstract

Background: Current guidelines recommend that the gastroenterologist-nurse team deliver sedation to low-risk patients undergoing colonoscopy screening. Yet a 2012 study demonstrated that professional anesthesia service (PAS) use increased from 14% in 2003 to over 30% in 2009, and more than two-thirds of PAS was delivered to low-risk patients. Recently, the Centers for Medicare and Medicaid Services stated PAS use was becoming the standard of care and proposed waiving the copayments for Medicare patients undergoing screening. The cost and benefits of this policy change are unknown. Objective: To estimate the association between PAS use in screening colonoscopies and colorectal cancer screening rates (benefit), and the PAS cost associated with each additional colorectal cancer prevented by increasing PAS use. Data: We used 2008-2012 Medicare claims data to derive the rate of PAS use for fee-for-service beneficiaries during colonoscopy, and 2008-2012 Behavioral Risk Factor Surveillance System Survey (BRFSS) data to estimate colorectal cancer screening rates. Methods: Rates for PAS, colonoscopy and overall cancer screening rates (including fecal occult blood test) were constructed for the 150 metropolitan statistical areas (MSA) that had both BRFSS and LDS data during 2008-2012. Colonoscopies and PAS use were identified based on CPT-4 codes, which were linked based on service date and location. The PAS rate was defined as the proportion of colonoscopies with PAS. The colonoscopy screening and colorectal cancer screening rates were defined as proportion of eligible individuals in compliance with the CDC's guideline on screenings. Sampling weights were used to generate MSA level estimates. Combining our estimates with those from the published literature, we approximated the increase in PAS cost associated with the detection of one additional case colorectal cancer. Results: From 2008 to 2012, colonoscopy screening rates increased from 63% to 70%, overall colorectal cancer screening rates from 71% to 75%, and PAS use from 32% to 42%. PAS use was positively correlated with colonoscopy screening rates (rho=0.180, p 0.050). PAS cost associated with each additional colorectal cancer prevented was estimated to be $16.6 million (95% CI: $11.0 million, $33.2 million) in 2014 U.S. dollars. Conclusions: PAS use in colonoscopies was modestly associated with colonoscopy screening rates but not with overall colorectal cancer screening rates. Improving coverage of PAS during screening colonoscopies is unlikely to increase screening in a cost-effective fashion.