Colonoscopies Are Overprescribed, Study Says

The overuse of colonoscopies in patients in this study alone costs the health care system about $1 million.

Researchers have recently found that many antibiotic prescriptions are written and prescribed without reason. In addition, researchers have also found that hospitals are ordering and performing a lot—almost 30 percent—of unnecessary tests. Now, you can add one more procedure to the “too much” list: colonoscopies.

A new study led by researchers at Brigham and Women’s Hospital (BWH) found “an overuse of colonoscopies for colorectal cancer screening and surveillance.” According to the report, endoscopists are recommending shorter follow-up times than what the established guidelines recommend, and this has led to significant overuse of the procedure.

“Our study shows that a high percentage of follow-up colonoscopies are being performed too early, resulting in use of scarce health care resources with potentially limited clinical benefit,” said Thomas D. Sequist, a physician in the division of general medicine and primary care at BWH and the study’s senior author, in a statement.

The study was published September 30 in the Journal of General Internal Medicine.

The study was a “retrospective cohort study,” in which the researchers went through the electronic health record data of 1,429 primary care patients at Harvard Vanguard Medical Associates ages 50 to 65 who had a screening colonoscopy between 2001 and 2010.

According to the researchers:

88 percent of follow-up screening colonoscopies and 49 percent of surveillance colonoscopies repeated during the study represented overuse—meaning they were performed more than one year early, and often times over three to four years earlier than is recommended by national guidelines. At the same time, one-quarter of study patients identified as higher risk based on initial colonoscopy findings failed to receive follow-up colonoscopy within the recommended three or five year time period.

“Previous research has shown that most endoscopists do not consistently agree with the follow-up intervals recommended in national guidelines and report preferences for shorter screening and surveillance intervals,” Sequist said in a statement. “Examining practice variation and establishing locally endorsed standards among endoscopists may be a way to target interventions to reduce overuse. There are likely multiple drivers of recommendations for early colonoscopy, including disagreement with current guidelines, fear of poor patient outcomes or malpractice, or misaligned financial incentives.”

The study found that early colonoscopy was recommended by endoscopists “following more than one-half of the initial colonoscopies.” Patients were 13 times more likely to undergo an early colonoscopy when their endoscopist recommended the procedure, even when it wasn’t necessary.

“The overused colonoscopies on the patients in this study alone represent a potential excess of over $1 million in health care spending—resources that might benefit those who are overdue for colon cancer screening,” said Gina Kruse, a physician at Massachusetts General Hospital and the study’s lead author.