Abstract
BackgroundSurveillance in patients with previous polypectomy was underused in the Medicare population in 1994. This study investigates whether expansion of Medicare reimbursement for colonoscopy screening in high-risk individuals has reduced the inappropriate use of surveillance.MethodsWe used Kaplan-Meier analysis to estimate time to surveillance and polyp recurrence rates for Medicare beneficiaries with a colonoscopy with polypectomy between 1998 and 2003 who were followed through 2008 for receipt of surveillance colonoscopy. Generalized Estimating Equations were used to estimate risk factors for: 1) failing to undergo surveillance and 2) polyp recurrence among these individuals. Analyses were stratified into three 2-year cohorts based on baseline colonoscopy date.ResultsMedicare beneficiaries undergoing a colonoscopy with polypectomy in the 1998–1999 (n = 4,136), 2000–2001 (n = 3,538) and 2002–2003 (n = 4,655) cohorts had respective probabilities of 30%, 26% and 20% (p<0.001) of subsequent surveillance events within 3 years. At the same time, 58%, 52% and 45% (p<0.001) of beneficiaries received a surveillance event within 5 years. Polyp recurrence rates after 5 years were 36%, 30% and 26% (p<0.001) respectively. Older age (≥ 70 years), female gender, later cohort (2000–2001 & 2002–2003), and severe comorbidity were the most important risk factors for failure to undergo a surveillance event. Male gender and early cohort (1998–1999) were the most important risk factors for polyp recurrence.ConclusionsExpansion of Medicare reimbursement for colonoscopy screening in high-risk individuals has not reduced underutilization of surveillance in the Medicare population. It is important to take action now to improve this situation, because polyp recurrence is substantial in this population.
Highlights
Individuals in whom adenomas have been detected are considered to be at increased risk of developing colorectal cancer (CRC), even after the adenomas have been removed [1]
Two studies evaluating the utilization of surveillance colonoscopy in adenoma patients were recently published [5,6]
We investigated whether expansion of Medicare reimbursement for colonoscopy screening in high-risk individuals has affected the under- and overutilization of surveillance in this population
Summary
Individuals in whom adenomas have been detected are considered to be at increased risk of developing colorectal cancer (CRC), even after the adenomas have been removed [1]. These high-risk individuals are recommended to undergo regular surveillance with colonoscopy (every five years if 1–2 adenomas smaller than 1 cm, every 3 years otherwise) [2]. Two studies evaluating the utilization of surveillance colonoscopy in adenoma patients were recently published [5,6]. This study investigates whether expansion of Medicare reimbursement for colonoscopy screening in high-risk individuals has reduced the inappropriate use of surveillance
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