Zafar Hanna M, Yang Jianing, Armstrong Katrina, Groeneveld Peter
Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104.
American Academy of Dermatology, Schaumburg, Illinois.
Acad Radiol. 2015 Jul;22(7):807-13. doi: 10.1016/j.acra.2015.03.002. Epub 2015 Apr 15.
To compare differences in Medicare costs 1 year after initial computed tomographic colonography (CTC) or initial optical colonoscopy (OC).
We performed a retrospective cohort study of asymptomatic Medicare outpatients aged ≥ 66 years who received initial CTC (n = 531) or OC (n = 17,593) between January 2007 and December 2008; initial OC patients were matched on county of residence and year of screening. Outcomes included differences in total inpatient and outpatient Medicare costs 1 year after initial CTC or OC and differences in outpatient testing of potential findings in the colon, abdomen, pelvis, and lungs.
Higher adjusted costs per patient were revealed in the year after initial CTC compared to initial OC for outpatient testing related to potential colonic ($50; 95% confidence interval [CI], $12-$88; P = .010) and extracolonic findings ($64; 95% CI, $23-$106; P = .002). However, there were no differences in adjusted total costs per patient in the year after either modality ($2065; 95% CI, $1672-$5803; P = .28). Similarly, adjusted costs did not differ between cohorts for inpatient ($267; 95% CI, $1017-$1550; P = .68) or outpatient care ($2828; 95% CI, $311-$5966; P = .08).
Despite higher adjusted costs of outpatient testing potentially related to colonic and extracolonic findings among asymptomatic elderly patients 1 year after initial CTC compared to OC, we found no differences in adjusted total, inpatient, or outpatient costs between cohorts. Although Medicare does not cover screening CTC, our results suggest that these modalities generate comparable downstream costs to payers.
比较初次计算机断层结肠成像（CTC）或初次光学结肠镜检查（OC）后1年医疗保险费用的差异。
我们对2007年1月至2008年12月期间接受初次CTC（n = 531）或OC（n = 17,593）的年龄≥66岁的无症状医疗保险门诊患者进行了一项回顾性队列研究；初次OC患者按居住县和筛查年份进行匹配。结果包括初次CTC或OC后1年住院和门诊医疗保险总费用的差异，以及结肠、腹部、骨盆和肺部潜在检查结果的门诊检查差异。
与初次OC相比，初次CTC后1年，与潜在结肠病变相关的门诊检查（50美元；95%置信区间[CI]，12 - 88美元；P = 0.010）和结肠外检查结果（64美元；95% CI，23 - 106美元；P = 0.002）的每位患者调整后费用更高。然而，两种检查方式后1年每位患者的调整后总费用无差异（2065美元；95% CI，1672 - 5803美元；P = 0.28）。同样，住院（267美元；95% CI，1017 - 1550美元；P = 0.68）或门诊护理（2828美元；95% CI，311 - 5966美元；P = 0.08）队列之间的调整后费用也无差异。
尽管与初次OC相比，初次CTC后1年无症状老年患者中与结肠和结肠外检查结果潜在相关的门诊检查调整后费用更高，但我们发现队列之间的调整后总费用、住院费用或门诊费用无差异。尽管医疗保险不涵盖筛查CTC，但我们的结果表明，这些检查方式给支付方带来的下游成本相当。
