Modestly Increased Use of Colonoscopy When Copayments Are Waived

Shabnam Khatami, Lei Xuan, Rolando Roman, Song Zhang, Charles McConnel, Ethan A. Halm, Samir Gupta

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background & Aims: Colorectal cancer (CRC) screening with colonoscopy often requires expensive copayments from patients. The 2010 Patient Protection and Affordable Care Act mandated elimination of copayments for CRC screening, including colonoscopy, but little is known about the effects of copayment elimination on use. The University of Texas employee, retiree, and dependent health plan instituted and promoted a waiver of copayments for screening colonoscopies in fiscal year (FY) 2009; we examined the effects of removing cost sharing on colonoscopy use. Methods: We conducted a retrospective cohort study of 59,855 beneficiaries of the University of Texas employee, retiree, and dependent health plan, associated with 16 University of Texas health and nonhealth campuses, ages 50-64 years at any point in FYs 2002-2009 (267,191 person-years of follow-up evaluation). The primary outcome was colonoscopy incidence among individuals with no prior colonoscopy. We compared the age- and sex-standardized incidence ratios for colonoscopy in FY 2009 (after the copayment waiver) with the expected incidence for FY 2009, based on secular trends from years before the waiver. Results: The annual incidence of colonoscopy increased to 9.5% after the copayment was waived, compared with an expected incidence of 8.0% (standardized incidence ratio, 1.18; 95% confidence interval, 1.14-1.23; P < .001). After adjusting for age, sex, and beneficiary status, the copayment waiver remained significantly associated with greater use of colonoscopy, with an adjusted hazard ratio of 1.19 (95% confidence interval, 1.12-1.26). Conclusions: Waiving copayments for colonoscopy screening results in a statistically significant, but modest (1.5%), increase in use. Additional strategies beyond removing financial disincentives are needed to increase use of CRC screening.

Original languageEnglish (US)
Pages (from-to)761-766
Number of pages6
JournalClinical Gastroenterology and Hepatology
Volume10
Issue number7
DOIs
StatePublished - Jul 2012

Fingerprint

Colonoscopy
Incidence
Early Detection of Cancer
Colorectal Neoplasms
Health
Cost Sharing
Patient Protection and Affordable Care Act
Confidence Intervals
Motivation
Cohort Studies
Retrospective Studies

Keywords

  • Colon cancer
  • Colorectal neoplasm
  • Cost sharing
  • Early detection

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Modestly Increased Use of Colonoscopy When Copayments Are Waived. / Khatami, Shabnam; Xuan, Lei; Roman, Rolando; Zhang, Song; McConnel, Charles; Halm, Ethan A.; Gupta, Samir.

In: Clinical Gastroenterology and Hepatology, Vol. 10, No. 7, 07.2012, p. 761-766.

Research output: Contribution to journalArticle

Khatami, Shabnam ; Xuan, Lei ; Roman, Rolando ; Zhang, Song ; McConnel, Charles ; Halm, Ethan A. ; Gupta, Samir. / Modestly Increased Use of Colonoscopy When Copayments Are Waived. In: Clinical Gastroenterology and Hepatology. 2012 ; Vol. 10, No. 7. pp. 761-766.
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