Purpose: Computed Tomographic Colonography (CTC) or “virtual colonoscopy” has been proposed as an alternative to conventional colonoscopy for colorectal carcinoma (CRC) screening. Although numerous studies have evaluated the clinical validity of CTC performance, no study has analyzed the potential economic impact of CTC implementation on the healthcare system. Methods: A mathematical model using estimates from the published literature was created to project the impact of CTC on colonoscopy utilization and the resulting financial consequences for society, hospitals (facilities) and endoscopists (physicians). Published reports, current practice recommendations and Medicare reimbursement data were used to estimate the potential economic impact if CTC becomes the primary screening test for CRC. Results: If CTC becomes the primary modality for CRC screening, 4.85 million (M) patients are projected to undergo CRC screening annually. The total societal cost of a CTC screening program is estimated to be $3.74 billion (B) annually, consisting of $3.06B in facility/hospital fees and $0.68B in physician fees. The total cost for CRC screening using CTC will be partially offset by a decrease in colonoscopy expenditures. The projected net decrease in colonoscopy utilization is highly dependent on the polyp size threshold used to define a positive CTC study; screening colonoscopies will be replaced by CTC, but this loss will be partially offset by colonoscopies generated for the follow-up of positive CTC studies. A 6 mm polyp size cut-off will lead to 0.57M fewer colonoscopies being performed, resulting in a $382M decrease in colonoscopy expenditures and a net $3.36B in total societal screening costs. A 10 mm polyp size cut-off will lead to 1.44M fewer colonoscopies, resulting in a $965M decrease in colonoscopy expenditures and a net $2.78B in total societal screening costs. Revenue to endoscopists will decrease by $128M with the 6 mm cut-off, while the 10 mm cut-off will result in a $324M decrease. Conclusions: If implemented as the primary modality for CRC screening, CTC will likely lead to a net decrease in colonoscopy utilization. Under the current reimbursement system, the majority of health care expenditures for CTC would go towards facility fees, with endoscopists likely to experience a decline in their revenues.
