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    HMOs Should Cover Full-Colon Exams, Researchers Say


    A second study by Amnon Sonnenberg, MD, and colleagues at the Veterans Affairs Medical Center in Albuquerque, N.M., found colonoscopy to be more cost-effective than either fecal occult blood test or sigmoidoscopy alone. Commenting on this study, University of Pennsylvania researcher James D. Lewis, MD, MSCE, suggests that colonoscopy is an attractive alternative for patients.

    "Some patients will prefer sigmoidoscopy or FOBT -- or some will prefer no screening -- but one advantage of screening colonoscopy is that it is one-stop shopping," Lewis tells WebMD. "It offers the opportunity for therapeutic intervention, while with each of the other strategies there is a need for an additional evaluation -- usually colonoscopy -- if there is a positive test result. With colonoscopy, you come once and you are finished. Plus, being screened only once every 10 years is very attractive compared to breast or cervical cancer, where there must be much more frequent screening."

    Currently, neither Medicare nor private insurers cover colonoscopy screening. This may not make good fiscal sense for Medicare, which covers patients from age 65 until the end of their lives. There is a question, however, whether it makes fiscal sense for private insurers to avoid the cost of colonoscopy. Duke University researcher Dawn Provenzale, MD, set out to answer this question by studying patients enrolled in the Duke HMO. She found that while colonoscopy increased screening costs more than it reduced cancer treatment costs, its benefits justified its expense.

    "Screening colonoscopy has an additional cost of $6,230 per life-year saved," Provenzale tells WebMD. "Screening mammography in patients over 50 [costs] $22,000 per life-year saved. So screening colonoscopy is more cost-effective than screening mammography. ... I am hopeful this will become part of our screening program at the Duke Managed Care System."

    Lewis puts it more simply. "The time has come for patients and clinicians to demand coverage for screening colonoscopy," he says. "When it comes to preventing and treating colorectal cancer, you can either pay now or pay later."

    For more information from WebMD, visit our Diseases and Conditions Center on Colorectal Cancer.

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