OBJECTIVES: For colonoscopy, one of the most relevant quality indicators is adenoma detection rate (ADR). Research shows an inverse relationship between adenoma detection rate and colorectal cancer incidence. Computer-aided detection (CAD) systems show enormous potential in improving ADR. However, the financial implications on the provider when implementing CAD remain unclear. This impact model aims to assess the relationship of CAD use in colonoscopies and provider reimbursement in Germany, France, and Italy.

METHODS: A decision-tree model analyzed the impact of standard colonoscopy versus CAD-supported colonoscopy on provider reimbursement in an outpatient setting. In the model, a patient may have a benign polyp, an adenoma, or nothing to detect. Adenomas are further categorised as being high risk, low risk, or cancerous. Provider case volume was measured as the total number of diagnostic-only or polypectomies performed. When a carcinoma is detected, in the model, an additional inpatient case for an endoscopic resection creates. Main outcome was the total reimbursement the provider received. Reimbursement data was obtained from national healthcare reimbursement databases.

RESULTS: Comparing an ADR of 35.0% for standard colonoscopy with a CAD ADR of 45.0%, calculated impact per 100 cases results in a higher proportion of patients switching from diagnostic-only to polypectomy at a constant case volume (41.1% and 58.9%, respectively). Reimbursement for the provider increases by 1.2%, 1.9% and 2.4% for Germany, France, and Italy, respectively. Considering additional hospital referrals for detected carcinomatous lesions following the initial colonoscopy the total patient procedure volume slightly increases by 1.5% and the aggregated reimbursement increase is 12.7%, 11.4% and 13.0% driven by the additional hospital cases, respectively.

CONCLUSIONS: Improvements in ADR through adoption of a CAD application results in minor changes in reimbursement for the healthcare provider within the initial colonoscopy case. It is likely that reduced reimbursement hurdles for adopting innovative technologies might improve uptake of CAD.