Table 2. Reimbursement for screening tests and for colonoscopy complications, and annual reimbursements for cancer care used in the analysis.
| Description | Reimbursement* ($) | |||
|---|---|---|---|---|
| Screening tests | ||||
| mtSDNA | 512 | |||
| FIT | 22 | |||
| gFOBT | 4 | |||
| Colonoscopy, without polypectomy, by indication | ||||
| - Screening | 735 | |||
| - Diagnostic | 639 | |||
| - Surveillance | 724 | |||
| Colonoscopy, with polypectomy | 870 | |||
| Sigmoidoscopy | 337 | |||
| Colonoscopy complications | ||||
| Serious GI complication (perforations, GI bleeding, transfusions) | 6,847 | |||
| Other GI complication (paralytic ileus, nausea and vomiting, dehydration, abdominal pain) | 4,878 | |||
| Cardiovascular complication (myocardial infarction or angina, arrhythmias, congestive heart failure, cardiac or respiratory arrest, syncope, hypotension, or shock) | 5,347 | |||
| Cancer care | ||||
| Annual reimbursement by stage at diagnosis ($) | ||||
| Phase of care† | I | II | III | IV |
| Initial phase | 33,341 | 47,283 | 67,300 | 97,931 |
| Continuing phase | 2,685 | 3,266 | 5,258 | 26,474 |
| Terminal phase, non-CRC death | 16,701 | 17,963 | 24,990 | 61,238 |
| Terminal phase, CRC death | 68,339 | 77,098 | 79,770 | 99,255 |
CRC = colorectal cancer; FIT = fecal immunochemical test; gFOBT = sensitive guaiac-based fecal occult blood test; GI = gastrointestinal; mtSDNA = multitarget stool DNA test.
* All costs are expressed in 2017 US dollars. Costs of stool-based tests are based on the 2017 Centers for Medicare and Medicaid Services Clinical Laboratory Fee Schedule. Costs of endoscopic procedures are based on 2014 average Medicare payments for a screening sigmoidoscopy and for each type of colonoscopy and include payments for pathology and anesthesia services.
† The initial phase of care is the first 12 months after diagnosis, the last year of life phase is the final 12 months of life, and the continuing phase is all the months between the initial and last year of life phases.