Ladabaum Uri, Levin Zachary, Mannalithara Ajitha, Brill Joel V, Bundorf M Kate
1] Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA [2] Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA.
Am J Gastroenterol. 2014 Oct;109(10):1513-25. doi: 10.1038/ajg.2014.64. Epub 2014 Jul 1.
Screening decreases colorectal cancer (CRC) mortality. The national press has scrutinized colonoscopy charges. Little systematic evidence exists on colorectal testing and payments among commercially insured persons. Our aim was to characterize outpatient colorectal testing utilization and payments among commercially insured US adults.
We conducted an observational cohort study of outpatient colorectal test utilization rates, indications, and payments among 21 million 18-64-year-old employees and dependants with noncapitated group health insurance provided by 160 self-insured employers in the 2009 Truven MarketScan Databases.
Colonoscopy was the predominant colorectal test. Among 50-64-year olds, 12% underwent colonoscopy in 1 year. Most fecal tests and colonoscopies were associated with screening/surveillance indications. Testing rates were higher in women, and increased with age. Mean payments for fecal occult blood and immunochemical tests were $5 and $21, respectively. Colonoscopy payments varied between and within sites of service. Mean payments for diagnostic colonoscopy in an office, outpatient hospital facility, and ambulatory surgical center were $586 (s.d. $259), $1,400 (s.d. $681), and $1,074 (s.d. $549), respectively. Anesthesia and pathology services accompanied 35 and 52% of colonoscopies, with mean payments of $494 (s.d. $354) and $272 (s.d. $284), respectively. Mean payments for the most prevalent colonoscopy codes were 1.4- to 1.9-fold the average Medicare payments.
Most outpatient colorectal testing among commercially insured adults was associated with screening or surveillance. Payments varied widely across sites of service, and payments for anesthesia and pathology services contributed substantially to total payments. Cost-effectiveness analyses of CRC screening have relied on Medicare payments as proxies for costs, but cost-effectiveness may differ when analyzed from the perspectives of Medicare or commercial insurers.
筛查可降低结直肠癌（CRC）死亡率。全国媒体已对结肠镜检查费用进行了仔细审查。关于商业保险人群的结直肠癌检测和费用支付，几乎没有系统的证据。我们的目的是描述美国商业保险成年人的门诊结直肠癌检测利用情况和费用支付情况。
我们对2009年Truven MarketScan数据库中160家自我投保雇主提供的非人头制团体健康保险的2100万18 - 64岁员工及家属的门诊结直肠癌检测利用率、检测指征和费用支付情况进行了一项观察性队列研究。
结肠镜检查是主要的结直肠癌检测方法。在50 - 64岁人群中，12%的人在1年内接受了结肠镜检查。大多数粪便检测和结肠镜检查与筛查/监测指征相关。女性的检测率更高，且随年龄增长而增加。粪便潜血试验和免疫化学试验的平均费用分别为5美元和21美元。结肠镜检查费用在不同服务地点之间以及同一地点内部存在差异。在办公室、门诊医院设施和门诊手术中心进行诊断性结肠镜检查的平均费用分别为586美元（标准差259美元）、1400美元（标准差681美元）和1074美元（标准差549美元）。35%和52%的结肠镜检查伴有麻醉和病理服务，平均费用分别为494美元（标准差354美元）和272美元（标准差284美元）。最常见的结肠镜检查编码的平均费用是医疗保险平均支付费用的1.4至1.9倍。
商业保险成年人中的大多数门诊结直肠癌检测与筛查或监测相关。不同服务地点的费用差异很大，麻醉和病理服务费用在总费用中占很大比例。结直肠癌筛查的成本效益分析一直依赖医疗保险支付费用作为成本的替代指标，但从医疗保险或商业保险公司的角度进行分析时，成本效益可能会有所不同。
