If You Pay, They Will Come

Ivanhoe Newswire
Wednesday, December 20, 2006; 12:00 AM

(Ivanhoe Newswire) -- If you want people to get a screening test, then pay for it.

That's the overriding message of a new study by Yale University researchers who gauged the use of colonoscopy to detect colon cancer both before and after Medicare started paying for the test.

Results showed the average rate of colonoscopy tripled between 1992 and 1997 and between 1998 and 2001, when limited coverage for the test went into effect. Between 1992 and 1997 and between 2001 and 2002, when full coverage was offered, the test was used about six-times more often.

Did greater use of the test lead to earlier diagnosis of colon cancer? The researchers report the percentage of people diagnosed in the earliest stage of the disease went from 22.5 percent to 25.5 percent to 26.3 percent, respectively, over the three time periods.

"Given that there are approximately 60,000 cases of colorectal cancer diagnosed annually among patients 65 years of age and older in the United States, even a 4-percent increase in the percentage of patients whose cancer is diagnosed at an early stage can have a substantial impact at the population level," write the authors.

A fellow investigator writing in an accompanying editorial agrees the findings are significant but questions whether universal use of the colonoscopy is really going to be worth the price.

Arden M. Morris, M.D., M.P.H., from the University of Michigan, writes, "While increasing access to care and improving compliance with recommended care is an undeniable good, providing screening colonoscopy to all is not realistic. The onus is on physicians and other primary care clinicians to capitalize on the momentum associated with screening colonoscopy to encourage other effective but less expensive forms of screening, such as fecal occult blood tests with sigmoidoscopy."

This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week. To subscribe, go to: http://www.ivanhoe.com/newsalert/.

SOURCE: The Journal of the American Medical Association, 2006;296: 2815-2822, 2855-2856