The Centers for Medicare and Medicaid Services has proposed to refuse coverage of computed tomography colonography for colorectal cancer screening.
“The evidence is inadequate to conclude that CT colonography (CTC) is an appropriate colorectal cancer screening test,” the agency said in a posting to its Web site.
The proposal followed a Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) meeting in which a majority of committee members expressed moderate confidence in the technology's ability to determine with adequate specificity and sensitivity the presence of polyps greater than 10 mm, but less confidence in detecting smaller polyps. Committee members expressed even less confidence in the technology's ability to increase overall cancer screening rates. Additionally, they said that it did not appear that CTC had a similar ratio of cost per life-years saved, compared with optical colonoscopy.
At that meeting, representatives of the U.S. Preventive Services Task Force reiterated its position that there is insufficient evidence to assess the benefits and harms of CTC.
When the Centers for Medicare and Medicaid Services (CMS) began its process of considering coverage of the technology in May 2008, it received 100 comments, 79 of which favored adding CTC as a Medicare-covered benefit.
Among those commenting in support of coverage for asymptomatic, average-risk patients over age 50 years were the American Cancer Society, American College of Radiology, American Gastroenterological Association, and the Medical Device Manufacturers Association.
In its comments, the AGA said that it would support coverage only if CMS required providers to meet technology, training, and reporting standards. CTC also should only be covered as part of Medicare's Coverage with Evidence Development process, said the AGA. At the November MEDCAC meeting, AGA reiterated its position.
In its evaluation, CMS said none of the available evidence focuses on “a population more representative of the Medicare population.” A younger population likely has a lower polyp prevalence, lower positive rates, and lower rates of referral to optical colonoscopy, the agency said. Further, since Medicare already covers screening tests known to lead to positive health outcomes, a new test should show evidence of increasing overall screening, according to the proposed decision. A new test should not lead to duplicative testing or switching from one test to another, and so far, there's nothing to say that CTC would lead to either of these scenarios, which would increase resource use, said CMS.
Finally, there are no data showing that screening with CTC leads to less cancer, the agency said.
CMS is accepting comments on this proposed decision until mid-March, but it is unlikely to change its direction by the time it makes its final decision shortly thereafter.
To view the proposal or to comment, go to http://tinyurl.com/dmpcok