Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
J Gen Intern Med. 2013 Sep;28(9):1208-14. doi: 10.1007/s11606-013-2414-4.
Although the Centers for Medicare and Medicaid Services (CMS) denied coverage for screening computed tomography colonography (CTC) in March 2009, little is understood about whether CTC was targeted to the appropriate patient population prior to this decision.
Evaluate patient characteristics and known relative clinical indications for screening CTC among patients who received CTC compared to optical colonoscopy (OC).
DESIGN/PARTICIPANTS: Cross-sectional study of all 10,538 asymptomatic Medicare beneficiaries who underwent CTC between January 2007 and December 2008, compared to a cohort of 160,113 asymptomatic beneficiaries who underwent OC, matched on county of residence and year of examination.
Patient characteristics and known relative appropriate and inappropriate clinical indications for screening CTC.
CTC utilization was higher among women, patients > 65 years of age, white patients, and those with household income > 75 % (p = 0.001). Patients with relatively appropriate clinical indications for screening CTC were more likely to undergo CTC than OC including presumed incomplete OC (OR 80.7, 95 % CI 76.01-85.63); sedation risk (OR 1.11, 95 % CI 1.05-1.17); and chronic anticoagulation risk (OR 1.46, 95 % CI 1.38-1.54), after adjusting for patient characteristics and known clinical indications. Conversely, patients undergoing high-risk screening, an inappropriate indication, were less likely to receive CTC (OR 0.4, 95 % CI 0.37-0.42). Overall, 83 % of asymptomatic patients referred to CTC had at least one clinical indication relatively appropriate for CTC (8,772/10,538).
During the 2 years preceding CMS denial for screening, CTC was targeted to asymptomatic patients with relatively appropriate clinical indications for CTC/not receiving OC. However, CTC utilization was lower among certain demographic groups, including minority patients. These findings raise the possibility that future coverage of screening CTC might exacerbate disparities in colorectal cancer screening while increasing overall screening rates.
尽管医疗保险和医疗补助服务中心（CMS）在 2009 年 3 月拒绝了筛查用计算机断层扫描结肠成像术（CTC）的保险范围，但在此决定之前，关于 CTC 是否针对适当的患者人群的了解甚少。
评估与光学结肠镜检查（OC）相比，接受 CTC 的患者的患者特征和已知的相对临床适应证。
设计/参与者：对 2007 年 1 月至 2008 年 12 月间进行 CTC 的所有 10538 名无症状医疗保险受益人的横断面研究，与 160113 名接受 OC 的无症状受益人的队列进行比较，根据居住的县和检查年份进行匹配。
患者特征和已知的相对适当和不适当的筛查 CTC 的临床适应证。
女性、65 岁以上的患者、白人患者和家庭收入超过 75%的患者（p=0.001）更倾向于接受 CTC。与 OC 相比，有相对适当的筛查 CTC 适应证的患者更可能接受 CTC，包括疑似不完全 OC（OR 80.7，95%CI 76.01-85.63）；镇静风险（OR 1.11，95%CI 1.05-1.17）；和慢性抗凝风险（OR 1.46，95%CI 1.38-1.54），在调整了患者特征和已知的临床适应证后。相反，接受高危筛查的患者，即不适当的适应证，不太可能接受 CTC（OR 0.4，95%CI 0.37-0.42）。总体而言，83%被转诊至 CTC 的无症状患者至少有一种相对适合 CTC（8772/10538）的临床适应证。
在 CMS 拒绝用于筛查的前 2 年中，CTC 针对有相对适合 CTC 的临床适应证的无症状患者/未接受 OC 进行了靶向治疗。然而，在某些人群中，包括少数民族患者，CTC 的使用率较低。这些发现表明，未来对筛查 CTC 的覆盖范围可能会加剧结直肠癌筛查的差异，同时提高总体筛查率。
