Colorectal cancer screening use among insured adults: Is out-of-pocket cost a barrier to routine screening?

Perisetti, Abhilash; Khan, Hafiz; George, Nayana; Rafiq, Aamrin; Blakely, Summre; Rasmussen, Drew; Villalpando, Nathan; Goyal, Hemant

doi:10.4292/wjgpt.v9.i4.31

Cited by 22 publications

(19 citation statements)

References 28 publications

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“…These differences in coverage translate into differences in the level of healthcare provision, the access to healthcare services and may even influence the adherence to screening programs. Indeed, out of pocket costs and limited financial resources have been significantly associated to lack of adherence to CRC screening [58]. These factors may thus influence the estimation of the effectiveness of CRC screening programs, affecting in turn the conclusions of the economic studies conducted.…”

Section: Discussionmentioning

confidence: 99%

Economic evaluations of screening strategies for the early detection of colorectal cancer in the average-risk population: A systematic literature review

Mendívil

Appierto²,

Aceituno³

et al. 2019

PLoS ONE

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BackgroundColorectal cancer (CRC) screening has proven effective in reducing CRC mortality. This study aimed to systematically review, and evaluate the reporting quality, of the economic evidence regarding CRC screening in average-risk individuals.MethodsDatabases searched included Medline, EMBASE, National Health Service Economic Evaluation, Database of Abstracts of Reviews of Effects, Cost-Effectiveness Analysis registry, EconLit, and Health Technology Assessment database. Eligible studies were cost-effectiveness and cost-utility analyses comparing CRC screening strategies in average-risk individuals, published in English or Spanish, between January 2012 and November 2018. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.ResultsOf 1,993 publications initially retrieved, 477 were excluded by duplicate review, 1,449 by title/abstract review, and 34 by full-text review. Finally, 33 publications were included in the qualitative synthesis. Most studies were conducted in Europe (36,4%), followed by United States (24,2%) and Asia (24,2%). The main screening modalities considered were fecal immunochemical tests (70%), colonoscopy (67%), guaiac fecal occult blood test (42%) and flexible sigmoidoscopy (30%). In most studies, CRC screening was deemed cost-effective compared to no screening. Sensitivity analyses indicated that cost of CRC screening tests, adherence to screening, screening test sensitivity, and cost of CRC treatment had the greatest impact on cost-effectiveness results across studies. The majority of studies (73%) adequately reported at least 50% of the items included in the CHEERS checklist. Least well reported items included setting, study perspective, discount rate, model choice, and methods to identify effectiveness data or to estimate resource use and costs.ConclusionsCRC screening is an efficient alternative to no screening. Nevertheless, it is not possible to conclude which strategy should be preferred for population-based screening programs. Although we observed an overall good adherence to CHEERS recommendations, there is still room for improvement in economic evaluations reporting in this field.

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Section: Discussionmentioning

confidence: 99%

Economic evaluations of screening strategies for the early detection of colorectal cancer in the average-risk population: A systematic literature review

Mendívil

Appierto²,

Aceituno³

et al. 2019

PLoS ONE

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“…Post-colonoscopy CRC (PC-CRC) and CRC-related mortality are inversely related to the adenomas detected during colonoscopy [ 9 , 10 , 11 , 12 ]. In addition, there are also various other tools, such as blood tests, stools teats, and imaging modalities, that aid in the screening for CRC [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Scope of Artificial Intelligence in Screening and Diagnosis of Colorectal Cancer

Goyal

Mann

Gandhi

et al. 2020

JCM

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Globally, colorectal cancer is the third most diagnosed malignancy. It causes significant mortality and morbidity, which can be reduced by early diagnosis with an effective screening test. Integrating artificial intelligence (AI) and computer-aided detection (CAD) with screening methods has shown promising colorectal cancer screening results. AI could provide a “second look” for endoscopists to decrease the rate of missed polyps during a colonoscopy. It can also improve detection and characterization of polyps by integration with colonoscopy and various advanced endoscopic modalities such as magnifying narrow-band imaging, endocytoscopy, confocal endomicroscopy, laser-induced fluorescence spectroscopy, and magnifying chromoendoscopy. This descriptive review discusses various AI and CAD applications in colorectal cancer screening, polyp detection, and characterization.

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“…Outpatient endoscopy centers usually deal with high-volume and close-contact procedures, which could make them prone to become high-risk COVID-19 transmission areas if extreme precautions are not taken. Millions of colonoscopies are performed as part of the colorectal cancer screening program in the United States (US) (12,13). A wide variety of other therapeutic endoscopic procedures are also performed on a regular basis (14).…”

Section: Introductionmentioning

confidence: 99%

Gastrointestinal Endoscopy in the Era of COVID-19

2020

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Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which led to a worldwide pandemic that started in early 2020. Healthcare systems across the world encountered an unprecedented surge of COVID-19 patients resulting in more than half a million deaths globally. COVID-19 has affected multiple sub-specialties and procedure-related fields, including gastroenterology. Gastrointestinal (GI) endoscopy centers are specialized units where thousands of endoscopies are performed annually. A significant proportion of these procedures are affected due to the national and regional lockdowns across the globe. To adapt to this rapidly evolving situation, endoscopy centers have undergone significant changes and have taken unprecedented precautions to avoid the transmission of the virus. However, endoscopy centers are going through financial strain due to a reduction in the number of procedures from lockdowns and fear of virus transmission. Theoretically, endoscopies could add to the disease transmission as SARS-CoV-2 has shown to be present in the GI secretions. Multiple precautions such as mandatory use of face masks, safe distancing, use of barriers between the endoscopists and patients, negative pressure rooms, extended use of personal protective equipment, and volume reduction have been taken to decrease the risk of disease transmission by these centers. Moreover, pre-endoscopy COVID-19 testing has now become the norm. In this review, we highlight the significant changes assumed by the endoscopy center. Furthermore, we discuss cost-related concerns of pre-endoscopy COVID-19 testing, the downtime and delays related to the procedures, and effects of rescheduling. As the pandemic progresses through multiple phases, endoscopy centers should use a dynamic approach to adapt and strive to provide the best patient care.

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Colorectal cancer screening use among insured adults: Is out-of-pocket cost a barrier to routine screening?

Cited by 22 publications

References 28 publications

Economic evaluations of screening strategies for the early detection of colorectal cancer in the average-risk population: A systematic literature review

Economic evaluations of screening strategies for the early detection of colorectal cancer in the average-risk population: A systematic literature review

Scope of Artificial Intelligence in Screening and Diagnosis of Colorectal Cancer

Gastrointestinal Endoscopy in the Era of COVID-19

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