To view the proposed decision or to comment, go to http://tinyurl.com/dmpcok
The Centers for Medicare and Medicaid Services has proposed to refuse coverage of CT 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 follows a November 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.
There were lengthy debates about potential radiation exposure, the implications of extracolonic findings, and of CTC's apparent lack of precision in detecting smaller polyps.
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 began its process of considering coverage of the technology in May 2008, it received 100 comments, 79 of which were in favor of 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, and the American Gastroenterological Association.
In its comments, the AGA said that it would support coverage only if the 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, the AGA said. At the November MEDCAC meeting, the AGA reiterated its position.
The 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, the CMS said.
Finally, there are no data showing that screening with CTC leads to less cancer, the agency said.
The CMS, which accepted comments on this proposed decision until mid-March, was considered unlikely to change its direction by the time it makes its final decision shortly thereafter.