title: Colorectal testing utilization and payments in a large cohort of commercially insured US adults.
abstract: OBJECTIVE
  Screening decreases colorectal cancer (CRC) mortality. The national press has scrutinized colonoscopy charges. Little systematic evidence exists on colorectal testing and payments among commercially insured persons. Our aim was to characterize outpatient colorectal testing utilization and payments among commercially insured US adults.
  
  
  METHODS
  We conducted an observational cohort study of outpatient colorectal test utilization rates, indications, and payments among 21 million 18-64-year-old employees and dependants with noncapitated group health insurance provided by 160 self-insured employers in the 2009 Truven MarketScan Databases.
  
  
  RESULTS
  Colonoscopy was the predominant colorectal test. Among 50-64-year olds, 12% underwent colonoscopy in 1 year. Most fecal tests and colonoscopies were associated with screening/surveillance indications. Testing rates were higher in women, and increased with age. Mean payments for fecal occult blood and immunochemical tests were $5 and $21, respectively. Colonoscopy payments varied between and within sites of service. Mean payments for diagnostic colonoscopy in an office, outpatient hospital facility, and ambulatory surgical center were $586 (s.d. $259), $1,400 (s.d. $681), and $1,074 (s.d. $549), respectively. Anesthesia and pathology services accompanied 35 and 52% of colonoscopies, with mean payments of $494 (s.d. $354) and $272 (s.d. $284), respectively. Mean payments for the most prevalent colonoscopy codes were 1.4- to 1.9-fold the average Medicare payments.
  
  
  CONCLUSIONS
  Most outpatient colorectal testing among commercially insured adults was associated with screening or surveillance. Payments varied widely across sites of service, and payments for anesthesia and pathology services contributed substantially to total payments. Cost-effectiveness analyses of CRC screening have relied on Medicare payments as proxies for costs, but cost-effectiveness may differ when analyzed from the perspectives of Medicare or commercial insurers.
authors: 1] Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA [2] Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
authors: Uri
authors: U
authors: Ladabaum
authors: Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA.
authors: Zachary
authors: Z
authors: Levin
authors: 1] Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA [2] Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
authors: Ajitha
authors: A
authors: Mannalithara
authors: Predictive Health, Paradise Valley, Arizona, USA.
authors: Joel V
authors: JV
authors: Brill
authors: 1] Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA [2] National Bureau of Economic Research, Cambridge, Massachusetts, USA.
authors: M Kate
authors: MK
authors: Bundorf
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D000758:Anesthesia / Q000191:economics / Q000706:statistics & numerical data; D019411:Clinical Laboratory Techniques / Q000191:economics / Q000706:statistics & numerical data; D015331:Cohort Studies; D023881:Colonography, Computed Tomographic / Q000191:economics / Q000706:statistics & numerical data; D003113:Colonoscopy / Q000191:economics / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D005260:Female; D005102:Health Expenditures; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D014481:United States; D055815:Young Adult