Virtual Colonoscopy Misses Mark on Cost
By Charles Bankhead, Staff Writer, MedPage Today
Published: July 28, 2010
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
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Action Points
Explain to interested patients that a statistical analysis indicated that virtual colonoscopy would not be cost-effective compared with other types of colon cancer screening in most circumstances.
Note that the findings are based on computer models, not a randomized trial to compare different types of screening for colon cancer.
Virtual colonoscopy is cost-effective only when priced lower than conventional colonoscopy or if it attracts a large unscreened population, according to computer models of colon cancer screening strategies.
The models showed that Medicare patients would gain fewer life-years with CT colonography -- CTC, or virtual colonoscopy -- than with conventional colonoscopy performed every 10 years and about the same number afforded by flexible sigmoidoscopy performed every five years.
If reimbursed at about $500, CT colonography every five years would be the most costly form of screening for colon cancer, according to Amy B. Knudsen, PhD, of Massachusetts General Hospital in Boston, and colleagues.
The newer technology would become cost-effective only if the price per scan dropped to $205 or less or if adherence to CT colonography was 25% better compared with other tests, they reported online in the Journal of the National Cancer Institute.
"Our results suggest that CT colonography screening every five years provides a benefit in terms of life-years gained compared with no screening and provides only slightly fewer life-years gained than colonoscopy screening every 10 years," they wrote in conclusion.
"If CT colonography screening is reimbursed at roughly the same rate as colonoscopy, the cost, relative to the benefit derived and to the availability and costs of other colorectal cancer screening tests, is too high for it to be a cost-effective screening strategy."
Virtual colonoscopy and conventional colonoscopy have similar sensitivity for detecting adenomas 10 mm or larger. The former offers the attraction of being less invasive, although patients must still undergo extensive bowel preparation before CT colonography. Moreover, a suspicious lesion detected by CT colonography requires a patient to undergo colonoscopy for biopsy or to remove the lesion.
Last year, the Centers for Medicare and Medicaid Services (CMS) refused to cover CT colonography for its beneficiaries, finding the evidence inadequate to support approval for reimbursement. In preparation for making a coverage decision, CMS requested analyses of CT colonography screening among Medicare enrollees.
Three members of the National Cancer Institute's Cancer Intervention and Surveillance Modeling Network performed analyses, including Knudsen and co-authors. The JNCI article summarized the findings they reported to CMS.
For the analysis, the authors used three independently developed microsimulation models to assess outcomes and costs associated with CT colonography performed every five years.
They also compared the newer technology with screening tests already covered by Medicare: fecal occult blood test (FOBT), flexible sigmoidoscopy every five years with and without annual FOBT, and colonoscopy every 10 years.
Assumptions included referral for colonoscopy for any suspicious lesions 6 mm or larger detected by CT colonography and perfect adherence to all screening modalities.
The analyses showed that CT colonography would add 143 to 178 life-years per 1,000 65-year-olds screened. That compared with 152 to 185 life-years for conventional colonoscopy every 10 years, and 149 to 177 for flexible sigmoidoscopy every five years supplemented with annual FOBT.
If CT colonography were reimbursed at $488 -- slightly less than colonoscopy without polypectomy -- the imaging study would be the most costly of the screening options.
The authors determined that virtual colonoscopy would be cost-effective with reimbursement of $108 to $205, depending on which model was used. The imaging study also would be cost-effective if it attracted a large proportion of patients who are currently not screened.
Besides the inherent weaknesses of a computer model, the authors noted several other limitations to the study, including the fact that they did not consider risks and costs associated with radiation exposure in CTC or with the detection of findings outside the colon. Nor did they quality-adjust estimates of numbers of life-years.
Some of their assumptions might also have skewed the results. They assumed, for instance, that all 65-year-olds were previously unscreened and that individuals kept to the screening schedule.
The study was funded by the Agency for Healthcare Research and Quality.
The authors reported that they had no relevant disclosures.
Primary source: Journal of the National Cancer Institute
Source reference:
Knudsen AB, et al "Cost-effectiveness of computed tomographic colonography screening for colorectal cancer in the Medicare population" J Natl Cancer Inst 2010; DOI: 10.1093/jnci/djq242.
Michelle Obama Spearheads US Push Against Childhood Obesity
First Lady Michelle Obama on Tuesday launched a major push against childhood obesity, which affects around one in three US children and threatens to make the current generation of Americans the first to live shorter lives than their parents.
President Barack Obama signed an executive memorandum setting up a task force on obesity headed by the First Lady.
"My administration is committed to redoubling our efforts to solve the problem of childhood obesity within a generation through a comprehensive approach that builds on effective strategies, engages families and communities, and mobilizes both public and private sector resources," the memorandum said.
Click here to read more.
Giants Stadium Demolition
Today marks a solemn day for Giants fans, Jets fans, and concert lovers of New Jersey. Giants Stadium meets its maker this morning. The cranes are coming, the charges are set. Giants Stadium is coming down. Demolition of the most beloved venue in New Jersey began today at 10 A.M.
Giants Stadium opened in 1976 as the permanent home of the New York Giants and their three Super Bowl titles, later the New York Jets, the NY/NJ Generals of the USFL, the MetroStars/Red Bulls of MLS, World Cup games, high school football championships, plus thousands of concerts.
To read more and to see a demolition video, click here.
Do Not Drive Recalled Toyotas
U.S. Transportation Secretary Ray LaHood told a congressional hearing Wednesday people should stop driving any Toyota vehicles involved in a massive recall. "My advice is, if anybody owns one of these vehicles, stop driving it, take it to the Toyota dealer because they believe they have the fix for it," said LaHood. “We need to fix the problem so people don't have to worry about disengaging the engine or slamming the brakes on or put it in neutral.”
Shares in the Japanese automaker fell more than seven per cent to $72.62 U.S. on the New York Stock Exchange on news of the secretary's comments. The automaker has recalled some 2.5 million vehicles in the U.S. and Canada over concerns about sticky accelerators. LaHood said he also wants to talk with Toyota about the response by the automaker to consumer complaints. “We're not finished with Toyota,” LaHood said in an email to Reuters.
Toyota has already ruled out electronics as a cause of sudden acceleration by its cars. Millions of Toyota cars have been recalled internationally because of sticky gas pedals. The U.S. Government is also considering civil penalties against Toyota, the world's largest automaker, for its handling of the recall crisis. Suggestions have been made that Toyota may not be doing all it can to resolve the accelerator pedal problems. Toyota began shipping steel plates to U.S. dealers Monday as a fix for the sticky gas pedals. Recalls have reached 2.57 million vehicles in the U.S. and Canada alone.
Groundhog Day 2010
Today is celebrated as Groundhog Day, but did the grundhog see his shadow? One prediction is made from Punxsutawney in South Pennsylvania, the other is made by Chuck in Staten Island. Punxsutawney did see his shadow which means we have to wait 6 more weeks to enjoy Spring. Chuck did not see his shadow which means Spring will arrive in two weeks. People are confused on which groundhog to believe. The holiday, which began as a Pennsylvania German custom in southeastern and central Pennsylvania in the 18th and 19th centuries has its origins in ancient European Weather Lore, wherein a badger or sacred bear is the prognosticator as opposed to a groundhog.
Black History Month 2010
Black History Month starts today! Black History Month is celebrated in February in the United States and Canada. During Black History Month 2010, there are various events to educate and inspire. Black History Month 2010 is an opportunity to learn more about American history.
In 1926, Black History Month was originated by historian Carter G. Woodson as “Negro History Week”. The second week of February was chosen as that also marked the birthdays of former President Abraham Lincoln and former slave Frederick Douglass. The celebration was expanded to a month in 1976, the nation's bicentennial. President Gerald R. Ford urged Americans to “seize the opportunity to honor the too-often neglected accomplishments of black Americans in every area of endeavor throughout our history.” That year, fifty years after the first celebration, the association held the first African American History Month. By this time, the entire nation had come to recognize the importance of Black history in the drama of the American story. Since then each American president has issued African American History Month proclamations.
iPad, Apple's Newest Creation
The iPad, created by Apple was unveiled this week. The iPad was designed to bridge the gap between smartphones and laptops/notebooks. Apple's user friendly interface using the will hopefully spur developers to create medical applications to be used on the device. These applications can range from anything from E-Prescriptions to an application which reminds you when you are due for a checkup. We hope to see these kinds of applications created to make medical care a little easier for every patient.
For more information on the iPad please click here.
Toyota Safety Recall
Toyota announced yesterday that it is instructing Toyota dealers to temporarily suspend sales of eight models involved in the recall for sticking accelerator pedal. Toyota announced it would recall approximately 2.3 million vehicles to correct sticking accelerator pedals on specific Toyota Division Models. There is a possibility that certain accelerator pedal mechanisms may, in rare instances, mechanically stick in a partially depressed position or return slowly to the idle position.
Toyota’s accelerator pedal recall and suspension of sales is confined to the following Toyota Division vehicles:
2009-2010 RAV4,
2009-2010 Corolla,
2009-2010 Matrix,
2005-2010 Avalon,
Certain 2007-2010 Camry,
2010 Highlander,
2007-2010 Tundra,
2008-2010 Sequoia
New Diabetes Drug Approved
Victoza, a once-daily injection to treat type 2 diabetes in adults, was approved by the FDA on January 26th. Diabetes is a leading cause of death and disability, with more than 1.5 million new cases diagnosed annually. Controlling blood sugar levels is very important to preventing or reducing the long term complications of diabetes, and Victoza offers certain patients with type 2 diabetes a treatment option for controlling their blood glucose levels. We are glad to see another treatment for diabetes as it is a leading cause of death in the U.S.
To find out more about Victoza, click here.
W.L. Gore Associates
W.L. Gore Associates, a privately-owned corporation based out of Newark, Delaware, has once again been listed on Fortune's 100 Best Companies to Work For list, coming in this year at #13. W.L Gore Associates is a manufacturing company specializing in materials and products derived from fluoropolymers. They are famous for their Gore-Tex fabric, which is a waterproof, breatheable material often used in rain coats and other outerwear. W.L. Gore Associates has been on the Forbes 100 Best Companies to Work For list for all 13 years that the list has been published.
W.L. Gore Associates also has a large medical products division. This branch is responsible for production of medical supplies such as vascular grafts, guards and patches, endoprosthesis items and other liners, mesh products and plugs used in various medical applications and surgical procedures. We applaud W.L. Gore Associates' continued success and recognition, and hope to see new innovations from Gore Medical Products that can help physicians and patients worldwide.
Adopt Haitian Orphans
More than 50 Haitian orphans landed in the United States on Tuesday and were immediately taken for medical check-ups, hospital officials said. Most of the children had already been in the process of being adopted by American families before the devastating earthquake shook Haiti last week. However, the destruction caused by the earthquake has caused the US to allow the orphans in for medical care and to speed up the adoption process, which can often take as long as 18 months. The families will no longer have to wait for passports to be provided by the Haitian government and other paperwork to be fully completed before being able to adopt the orphans. A similar process is taking place with Dutch families. A charter plane from the Netherlands will arrive in Haiti on Wednesday to pick up and transport 109 Haitian orpahans to the Netherlands. All but 9 of the group were already in the process of being adopted by the Dutch families and thus already have a home in the Netherlands. The rest will be moved into foster homes there while waiting for a suitable family.
Click here for the Reuters article on the topic.
Two and a Half Men Colonoscopy; Charlie Sheen
The popular CBS comedy, Two and a Half Men starring Charlie Sheen, will be airing January 18, 2010 at 9:00PM EST. This newest episode , entitled "Yay, No Polyps", features Charlie enduring a colonoscopy to get out of a trip to see Chelsea's parents.
Click here to see a preview at www.cbs.com
Tylenol Recall 2010
Johnson & Johnson, the makers of Tylenol, Motrin and Benadryl announced a "broad-based" recall of these and other drugs that were distributed across the United States as well as to the United Arab Emirates and Fiji. The recall is apparently due to an "unusual moldy, musty or mildew-like odor" coming from the products. The source of the odor has been traced to a chemical called 2,4,6-tribromoanisole (TBA), which is used to coat wooden pallets used to transport and store packaging materials. The odor was first reported in early 2008 but there was no recall issued until November 2009, when five lots of "Tylenol Arthritis Pain 100 Count With Ez-Open Cap" were recalled. This recall was later expanded in December to include all available lots of that product.
The latest recall covers 500 lots of Johnson & Johnson brand drugs. Consumers should stop using any drugs with the specified lot numbers and contact McNeil Consumer Health Care, the division of Johnson & Johnson responsible for distribution of the recalled medications, for a refund or replacement. For more information, consumers can call 1-888-222-6036 or log on to www.mcneilproductrecall.com.
American Red Cross Haiti Donations
The American Red Cross has started a viral donation campaign to raise funds to help the victims of the devastating earthquake in Haiti. The earthquake hit just 10 miles west of the capital, Porte-au-Prince and its 2 million inhabitants. The text message-based donation effort came shortly after Haitian-born musician Wyclef Jean launched his own fundraising campaign for his organization Yéle Haiti, a charity group also involved in the relief effort. This has become the largest-scale text message-based relief fundraising effort in history.
To help, you can text 'Yéle' to 501501 to donate $5 to Yéle Haiti or to donate $10 to the Red Cross relief effort, text "haiti" to 90999. The money will be automatically added to your cell phone bill. We encourage donation to these organizations but people must also be careful that they are donating to legitimate charities, as many scams and fraudulent groups have sprung up in the wake of the disaster as well. For more information, you can visit the Red Cross website at www.redcross.org
American Red Cross Haiti
The American Red Cross is mobilizing emergency funding and aid workers to be sent to Haiti in the aftermath of the 7.0 magnitude earthquake that struck just 10 miles west of Haiti's capital, Porte-au-Prince and the 2 million people who live there. The Inter-American Developmental Bank has already approved $200,000 in relief funding for the mission.
The Upper Palmetto Chapter of the American Red Cross is accepting donations to help in the area, where more than 3 million people are believed to be in need of emergency aid. We at Gupta Gastro associates hope that the American Red Cross is successful in raising enough money to help those in need.
Valerie Bertinelli to run 2010 Boston Marathon
Actress Valerie Bertinelli has agreed to run in the 114th Boston Marathon® on April 19, 2010 to support cancer research at the Dana-Farber Cancer Institute in Boston. The goal of the marathon, which will be undertaken by more than 500 runners this year, will be to raise $4.4 million dollars for the Claudia Adams Barr Program in Innovative Basic Cancer Research at Dana-Farber. The marathon has helped raise over $43 million for the Barr Program since 1990.
Bertinelli, who recently gained widespread popularity by losing 40 pounds on the famous Jenny Craig diet said "Running the Boston Marathon for Dana-Farber Cancer Institute is an undertaking that will test my endurance while allowing me the opportunity to raise critical funds for cancer research that will benefit people around the world.”
We fully support this important event and the innovations in cancer research that it will hopefully bring. For further information and to support Ms. Bertinelli's 2010 Boston Marathon run for the Dana-Farber Marathon Challenge please visit: