Colonoscopy remains high value preventive care

The United States Preventive Services Task Force and most gastroenterology organizations recommend that adults get screened for colorectal cancer (CRC) every 10 years beginning at age 50 via fecal occult blood testing (FOBT), sigmoidoscopy or colonoscopy. People at high risk are recommended to get screened earlier and sometimes more frequently.

“There’s enough data to show that if you catch colorectal cancer early enough it’s treatable,” says Brian Hemstreet, PharmD, FCCP, BCPS, associate professor and director of Pharmaceutical Care Learning Center, University of Colorado Anschutz Medical Campus. “Colon cancer is one of the top cancers in the U.S. so the impact of the screening is a lot higher than it is for some of the rarer cancers.”

Hemstreet says quandaries can occur because the right amount of surveillance for patients with a history of colon cancer is uncertain and colonoscopies can be very costly. In the long run, however, it’s more effective than managing patients with CRC.

 “Even if it only prevents two or three polyps from developing into full-blown cancer, from a monetary perspective it’s pretty cost-effective and far easier to manage than the alternative,” says Geoffrey Wall, PharmD, FCCP, BCPS, CGP, professor of clinical sciences, Drake University College of Pharmacy and Health Sciences and internal medicine clinical pharmacist, Iowa Methodist Medical Center.

Technology might cut back on the amount of colonoscopies conducted in the future. Hemstreet says CT scanning is rapidly approaching the level of accuracy that colonoscopies have. 

“While CT scans are certainly going to be expensive, they’re going to be less expensive than a full-blown colonoscopy,” he says. “It will help screen out patients who don’t need one, which of course makes them happy because not too many patients are jumping up and down to get a colonoscopy.”

MANAGEMENT AND PREVENTION

For the past eight years, Cigna has worked to combat CRC with an award-winning screening program. This past March, during National Colorectal Cancer Awareness Month, the program reached 2 million people that were due for a screening through online messages and direct mail. Highlights include:

• About 300,000 newly eligible individuals, age 50 through 64, whose claims data showed they hadn’t had a screening received information in the mail about CRC tests, including colonoscopy. Members also received information on dealing with CRC symptoms.

• The same members were offered the chance to request the InSure FIT screening kit, an at-home test that detects abnormalities in the lower gastrointestinal tract through a sample of fecal matter. Through an agreement with the manufacturer, the kits are free of charge and lab fees are covered as a preventive benefit. Confidential results are mailed to members who are encouraged to share with their physician.

• About 11,000 Cigna customers were selected to receive the InSure FIT kit because, based on Cigna claims data, they completed either the at-home kit or a FOBT in the last three years and did not get a follow-up colonoscopy or sigmoidoscopy this year.

• Members age 50 to 64 saw a targeted message about CRC screening and the InSure FIT kit when they logged on to Cigna’s web portal, myCigna.com.

The March 2012, the program reached nearly 542,000 customers. Claims data showed that nearly 31,000 had a screening-a rate of 5.7% compared to 4.4% in 2010.

Among the members, colonoscopies had the highest screening rate at 57% of all screenings, while the InSure FIT and the FOBT accounted for 43% of screenings. Fifty percent had normal findings, 48.8% detected polyps that were removed, and 1.2% resulted in a diagnosis of CRC.

Cigna also worked with supermarket operator Harris Teeter in 2012 to develop a campaign including e-cards and a newsletter. As a result, employees and beneficiaries had a screening rate of 20.6%-nearly four times the Cigna national average.