Universal access to virtual colonoscopy may be on the horizon
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www.medscape.com
December 06, 2013
Stronger advocacy efforts are needed to overcome the political wrangling that has long stymied universal access to virtual
colonoscopy in the United Sates, write radiologists in a review published in the December issue of the Journal of the American
College of Radiology.
The test, CT colonography (CTC), was approved for the screening of colorectal cancer by the US Food and Drug Administration
(FDA) in 2009, and has been endorsed by the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer,
and the American College of Radiology (ACR). However, it is not covered for reimbursement by the Centers for Medicare and
Medicaid Services' (CMS).
"There's no question in the expert community that CTC has been ready for prime time for a long time," lead author Abraham H.
Dachman, MD, professor of radiology at the University of Chicago Medical Center, told Medscape Medical News in an interview.
"I think the public and nongastroenterology community need to be educated to demand CMS reimbursement for CTC.... It makes
sense," Dr. Dachman emphasized, citing the large body of peer-reviewed supportive literature and continued need for legislative
efforts.
CTC is safe and cost-effective relative to traditional optical colonoscopy (OC), and the procedure can be carried out in a convenient
outpatient setting without sedation.
Its coverage by CMS would also extrapolate to third-party carriers, yielding a significant boost to flagging colorectal cancer
screening rates, which currently hover around 40%, he added.
According to Dr. Dachman and fellow author Judy Lee, MD, the key to winning CMS approval — denied largely as a result of
political controversy from the OC community — lies in upgrading the test's US Preventive Services Task Force (USPSTF) rating.
When it was categorized in 2008, evidence for the test was given an I rating, which is considered to be insufficient.
Changing the rating to at least B, denoting a high certainty of moderate to substantial net benefit, would influence CMS. "A lot of
third-party providers follow CMS rulings," Dr. Dachman noted, indicating his preference for an A rating, and adding that a C rating
would be "devastating."
However, efforts to effect the upgrade have been stuck in a governmental quagmire. "USPSTF claimed their agenda was 'full' last
year with more pressing issues and therapies to evaluate, and CTC evaluation was deferred, which put us off at least an extra
year," Dr. Dachman explained.
There is good news, however. After a long and torturous journey in muddled waters, the way might finally be clearing; the USPSTF
weighed evidence collected by the FDA in a fact-seeking session in September.
The meeting, which involved the agency's Gastroenterology-Urology Panel and the Radiological Devices Panel of the Medical
Devices Advisory Committee, included attendees such as Dr. Dachman and Dr. Yee, who presented data on behalf of the ACR.
"It is comforting to know that this federal agency within the US Department of Health and Human Services declared in its executive
summary following the meeting that 'all members of the joint panels agreed that given the risks and benefits identified, CTC should
be one option for colorectal cancer screening of asymptomatic patients'," Dr. Yee told Medscape Medical News.
"Since CMS and USPSTF take into consideration the risks and benefits of a test, the positive outcome of the evaluation by the
FDA will hopefully help to justify reimbursement of CTC for screening," Dr. Yee concluded.
Dr. Yee is professor and vice chair of radiology and biomedical imaging at the University of California, San Francisco; chief of
radiology at the San Francisco Veterans Affairs Medical Center; and a member of the ACR Colon Cancer Committee.
A Long and Winding Road Toward CMS Acceptance
Universal Access to Virtual Colonoscopy May Be on the Horizon
Yael Waknine