Questioning Colonoscopy Costs
ironjustice
Colonoscopies are **money makers** for a whole CROWD ..
http://www.eurekalert.org/pub_releases/2009-10/ncsu-ssh100609.php
Study shows how to lower costs, waiting times for colonoscopies
Colorectal cancer is a leading cause of cancer-related deaths in
the United States, leading to over 50,000 fatalities every year.
But it can be prevented with early screening using a procedure
called a colonoscopy.
Now researchers from North Carolina State University, Mayo
Clinic and the University of Massachusetts at Amherst (UMass)
have created a tool to help colonoscopy facilities operate more
efficiently, ultimately lowering costs and leading to shorter
waiting times for patients.
The researchers have created a computer model that "helps people
who manage colonoscopy facilities, such as hospitals and clinics,
find the best combination of physicians, staff, rooms and equipment
needed to cater to the number of patients they can expect," says
Bjorn Berg, lead author of the paper outlining the new tool and a
Ph.D. student in the Edward P. Fitts Department of Industrial &
Systems Engineering at NC State.
The model can also be used to determine the optimum number
of patients a facility can see in any given day.
"Colonoscopy facility managers can try out different ideas in
the model to see how they work before trying them in the real
world – which is an expensive place to experiment," says Dr.
Brian Denton, an assistant professor of industrial and systems
engineering at NC State and co-author of the paper.
"For example, a manager could see whether it is worthwhile to
hire another endoscopist who can perform colonoscopies, hire
another nurse, or add another recovery bed for the facility."
Denton explains that finding the right combination of staff,
equipment and rooms can be particularly challenging for
colonoscopy facilities because of uncertainties related to how
long it takes to perform the procedure and how long it takes a
patient to recover from it.
The model could be a boon for patients, because "it could lead
to efficiency gains for practices," Denton says, "and ultimately
lower the cost for patients." It also predicts the amount of time
patients will spend waiting for the procedure, and can be used
to improve scheduling.
The researchers utilized operations research methods to develop
their model, which uses mathematics as a way of studying
systems in order to make them more efficient and effective.
They are now working with University of North Carolina Hospitals
to implement the model, and ultimately hope to make it available
for general use.
###
The research, which was funded in part by the National Science
Foundation, was co-authored by Berg and Denton from NC State,
Dr. Hari Balasubramanian of UMass, and Dr. Heidi Nelson, Dr.
Keith Lindor, Ahmed Rahman and Angela Bailey of Mayo Clinic.
The paper, "A Discrete Event Simulation Model to Evaluate
Operational Performance of a Colonoscopy Suite," was published
online by the journal Medical Decision Making.
-----------------------------
"Raising serious concerns about their applicability"
"115 and 617 colonoscopies would be needed to prevent one CRC-related
death"
Cost effectiveness of colonoscopy, based on the appropriateness of an
indication.
Clin Gastroenterol Hepatol. 2008 Nov;6(11):1231-6.
Hassan C, Di Giulio E, Pickhardt PJ, Zullo A, Laghi A, Kim DH,
Iafrate
F, Morini S.
Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina
Margherita
Hospital, Rome, Italy. cesa...@hotmail.com
BACKGROUND & AIMS:
Determination of the appropriateness of an indication for colonoscopy
has been advanced as a means to help rationalize the use of
endoscopic
resources. However, the efficacy and cost effectiveness of the
current
guidelines used to select patients for colonoscopy are largely
unknown. The goal of this study was to assess the clinical and
economic impact of American Society for Gastrointestinal Endoscopy
and
the European Panel on the appropriateness of Gastrointestinal
Endoscopy appropriateness guidelines in selecting patients who are
referred for colonoscopy, in relation to colorectal cancer (CRC)
detection.
METHODS:
A decision-analysis model was constructed to compare colonoscopy
strategies for "appropriate" indications with those for which
colonoscopy is deemed "inappropriate" or "generally not indicated." A
50% cancer upstaging was modeled to simulate cancer progression for
patients not referred for colonoscopy. CRC prevalence was estimated
using a pooled data analysis based on a systematic review of the
literature. Costs of colonoscopy and cancer care were estimated from
Medicare reimbursement data. The number of colonoscopies needed to
detect one case of cancer and to prevent one cancer-related death and
incremental cost-effectiveness ratios (ICER), according to
appropriateness categories, were computed in a simulated population
of
patients that were 60 years of age and referred for colonoscopy.
RESULTS:
The numbers of appropriate and inappropriate colonoscopies that
needed
to be performed to detect one patient with cancer were 18 and 93,
respectively. Similarly, 115 and 617 colonoscopies would be needed,
respectively, to prevent one CRC-related death. The ICER for
appropriate and inappropriate colonoscopies, compared with a policy
of
not referring patients to colonoscopy, was $6154 and $31,807 per
life-
year gained, respectively. In a sensitivity analysis, only a
reduction
from the baseline value of 1.1% to 0.2% was associated with an ICER
for inappropriate colonoscopy higher than $150,000.
CONCLUSIONS:
Current guidelines regarding the appropriateness of colonoscopy are
relatively inefficient in excluding a clinically meaningful CRC risk
for patients in whom colonoscopy is generally not indicated, raising
serious concerns about their applicability to clinical practice.
PMID: 18995214
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Tom
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