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CMS: Insufficient data to provide coverage for CT colonography
The Centers for Medicare and Medicaid Services will accept public comments for 30 days before issuing a final decision.
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Due to insufficient data, CMS has issued a proposed decision memo stating that CT colonography for colorectal cancer screening will remain noncovered. The agency will take comments from the public for 30 days before making a final decision.
In September 2008, HemOnc Today reported the results from two studies published in The New England Journal of Medicine that supported the use of CT colonography for colorectal cancer screening. According to the data, CT colonography detected lesions measuring 10 mm or more in 90% of patients. However, the sensitivity of the method decreased with decreasing lesion size.
Systematic reviews and evidence-based guidelines, like those from the U.S. Preventive Services Task Force, did not support the use of routine screening before 2003, so the agency evaluated studies published after that date. In doing so, they stated that an insufficient amount of studies have focused on survival, though many have analyzed test characteristics.
According to the agency’s analysis, though CT scans and colonoscopy are equally effective at detecting larger polyps, CT scans are not as effective for detecting smaller polyps.
Additionally, many studies supporting virtual colonoscopy included patients with a mean age of 58 and, according to the agency, may not be relevant to Medicare’s older population.
Should the agency reverse its decision based on questions and comments from the public, the cost effectiveness of CT colonography will be analyzed. Therefore, the public is also urged to comment on this issue.