MEDCAC Meeting 11/19/2008 - Computed Tomography Colonography (CTC)

Barbara McNeil, MD PhD, Chair
Steve Pearson, MD, MSC, Vice-Chair
Steve E. Phurrough, MD, MPA, Coverage and Analysis Group
Maria Ellis, Executive Secretary

Download meeting minutes [PDF, 40KB].

MEDCAC Questions
Screening Computed Tomography Colonography (CTC) for Colorectal Cancer (CRC) for Average Risk Individuals

Use the following scale response for each of the questions below.

1. How confident are you that there is sufficient evidence to determine the sensitivity and specificity of screening CTC using at least 16 slice scanners for average risk individuals compared to optical colonoscopy for:
   

   1. Polyps < 6 mm
      
   2. Polyps 6 to < 10mm
      
   3. Polyps ≥ 10 mm

2. How confident are you that there is sufficient evidence to determine the health benefits of screening CTC using at least 16 slice scanners for average risk individuals compared to optical colonoscopy for:
   

   1. Polyps < 6 mm
      
   2. Polyps 6 to < 10mm
      
   3. Polyps ≥ 10 mm

3. How confident are you that previous evidence and modeling for the treatment of polyps discovered using other screening modalities can be applied to polyps discovered using screening CTC?

4. Based on the following discussion questions, how confident are you that the evidence demonstrates that screening CTC results in a net health benefit for Medicare beneficiaries similar to optical colonoscopy? (Net health benefits include the decrease in morbidity and mortality from the identification and removal of polyps balanced with the risks of the procedure and the identification of extracolonic abnormalities. It does not include costs.)

   Discussion questions:
   

   1. Does the health benefit depend upon polyp size, referral for colonoscopy and/or interval before subsequent screening? If so, what does the evidence demonstrate to be the appropriate recommendations for these factors?

      Note: All identified polyps are typically removed during optical colonoscopy regardless of their size. Guidelines for CTC must determine whether to refer all polyps or only those of certain sizes.

   2. Does the health benefit depend on the scanner resolution? If so, what does the evidence demonstrate to be the lowest resolution that should be used?

   3. Does the health benefit depend upon the skills of the individual performing and interpreting the screening CTC? What should be the minimal training and experience?

   4. How should extracolonic findings of CTC screening be reported and treated?

5. At the current Medicare prices, how confident are you that CTC has a similar ratio of cost per LYS (Life Years Saved) as optical colonoscopy? (Note: Interval for CTC screening and referrals for follow up by polyp size will be entered into the CEA modeling.)

6. How confident are you that the evidence demonstrates that the use of CTC screening in the average risk Medicare population will increase overall colorectal cancer screening rates in that population?

7. How confident are you that there is sufficient evidence to determine the appropriate CTC guidelines for referral for polyp removal and for frequency of screening?

Discussion question:
a. How can adherence to CTC guidelines and compliance with referrals for optical colonoscopy be monitored and maximized?

Download scoresheet [PDF, 77KB].