Economic Models of Colorectal Cancer Screening in Average-Risk Adults Workshop Summary (2005) / Chapter Skim
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Appendix M Recent Trends in Follow-up Surveillance in Medicare Beneficiaries--Todd Anderson, M.S.
Appendix M Recent Trends in Follow-up Surveillance in Medicare Beneficiaries--Todd Anderson, M.S.
Pages 220-231
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Please note that the data presented here do not reflect the views of CBO.
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And (2) What kinds of follow-up procedures occur in patients, patients with polyp(s)
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About 10-15 percent of Medicare beneficiaries enrolled in Medicare managed care plans in any year, and we have no claims data for that group. Claims data in this dataset are grouped by month.
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Because we were dealing with claims data, we had to rely on a record of an ICD-9 cancer diagnosis in any claim over the beneficiary's claim history. We defined as "potential cancer beneficiaries" any individuals who had a cancer diagnosis in at least two different months in the period.
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Those with shorter follow-up periods tended to have slightly lower rates of colonoscopy than those with longer periods. In examining data among various demographic subgroups, I noticed some interesting trends among some smaller subgroups.
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For those with 5 years of data available, 55 percent had had at least one colonoscopy in the period between 6 months and 5 years following the index polypectomy.
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We also cannot differentiate between polypectomies that arose out of a screening examination and those that occurred for diagnostic reasons. Nor can we differentiate between subsequent colonoscopies done for surveillance purposes and those done for diagnostic purposes.
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In this case we examined individuals in the sample in the period 1993-1999 and we eliminated all individuals who met the "possible cancer beneficiary" criterion. We defined a triggering event as any sigmoidoscopy that met the following criteria: · performed on a patient with at least 12 months of history in the sample, · no history of a sigmoidoscopy or colonoscopy in the previous 6 months; · no barium enema in the same or previous six months; · at least six months' worth of data available after the index date.
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228 ECONOMIC MODELS OF COLORECTAL CANCER SCREENING SLIDE 9 SLIDE 9 NOTES: In the universe of 6,257 sigmoidoscopy examinations associated with a polypectomy at any point in the succeeding six-months, fully 80 percent had the polypectomy in a subsequent colonoscopy, not in the initial sigmoidoscopy. Seventeen percent of the polypectomies occurred as part of the triggering sigmoidoscopy examination.
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APPENDIX M 229 SLIDE 10 SLIDE 10 NOTES: This chart examines in greater detail what happened to the 17 percent of polypectomies that occurred as part of the sigmoidoscopy, in the months following sigmoidoscopy. Here, 25 percent of the cases went on to have at least one other colorectal diagnostic procedure in the six months following the triggering event.
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230 ECONOMIC MODELS OF COLORECTAL CANCER SCREENING SLIDE 11 SLIDE 11 NOTES: The limitations of this part of the analysis are similar to those we encounter with the earlier analysis.
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APPENDIX M 231 SLIDE 12 SLIDE 12 NOTES: We conclude that somewhere between 55 and 64 percent of Medicare beneficiaries who undergo a polypectomy have at least one subsequent colonoscopy in the 5 year surveillance window. Diagnostic and therapeutic follow-up following a sigmoidoscopy is frequent, and a large majority of those how underwent polypectomy within six months of the sigmoidoscopy had their polyps removed in subsequent procedures.
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