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Nearly 30% of Patients Had Unnecessary Pre-Colonoscopy Visits

BALTIMORE – Gastroenterology office visits usually aren’t required before screening colonoscopy, according to a new study which finds that nearly 30% of patients have them anyway.

Widely used guidelines for colon cancer screening and polyp surveillance and the generally low risks associated with the colonoscopy procedure have made the prescreening office visit unnecessary in most cases, according to a research letter recently published in JAMA.

For the study, Johns Hopkins University School of Medicine researchers and colleagues analyzed billing data for privately insured patients under 65 to determine the proportion of colonoscopies for colon cancer screening and polyp surveillance that were preceded by office visits. Researchers also looked at the cost of those visits.

Background information in the article notes that open-access endoscopy, which allows patients to be referred for endoscopies without a prior gastroenterology office visit, began in the United States in the 1990s but that little research is available on the prevalence of the practice.

The researchers used MarketScan Commercial Claims and Encounters from Truven Health Analytics, a database that contains use and expenditure data for individuals with employer-sponsored private health insurance from several hundred U.S. employers and health plans, from 2010 through 2013. From the data, which includes approximately 43 to 55 million beneficiaries each year from all 50 states, study authors included patients age 50 to 64 years with continuous insurance coverage for 12 months prior to an outpatient colonoscopy performed in the gastroenterology setting that included a diagnosis for screening or polyp surveillance.

Results indicate that, of 842,849 patients who underwent colonoscopy, 29% had a pre-colonoscopy office visit. While patients with office visits had a higher Charlson Comorbidity Index (CCI) in general, 66% had a CCI of 0. Of the diagnoses for the office visits, 77% were related either to screening or preoperative evaluation.

With an average payment for office visits of $124 distributed across all patients, pre-colonoscopy office visits added an average of $36 per colonoscopy.

"Although the pre-colonoscopy office visits added a modest $36 per colonoscopy in this population, there are an estimated 7 million screening colonoscopies performed in the United States annually, so the cumulative costs are significant,” the study authors pointed out. “Identifying which patients benefit from a pre-colonoscopy office visit and targeting those patients could increase the value of colon cancer screening.”

Researchers note that the study is limited by their inability to determine why office visits were required.