Colonoscopy and fecal occult blood test use in Germany: results from a large insurance-based cohort

Background and study aims: Colonoscopy and guaiac-based fecal occult blood tests (FOBT) are recommended and offered for colorectal cancer (CRC) screening in Germany. We aimed to explore their utilization in a large insurance-based cohort. Patients and methods: Claims data from between 2000 and 2008 were collected for 170493 individuals who were insured by a large health insurance plan in the federal state of Hesse, Germany. The percentages of individuals who had recently utilized CRC screening-related procedures were calculated. Additionally, multiple test use and identification of CRC screening providers were ascertained. Results: Following the inception of the current CRC screening program in 2002, colonoscopy utilization rates varied only slightly and FOBT use decreased in individuals aged >= 50 years. At the end of 2008, the age-standardized percentages of individuals who had undergone colonoscopy within <= 10 years were 23% for men and 26% for women. The proportions of individuals who had used FOBT within <= 1 year were 14% for men and 22% for women. Patient education had been utilized by 38% of eligible persons and was increasingly followed by screening colonoscopy. For women, practices that specialized in gynecology were the main providers of FOBT (93%) and patient education (61%). Conclusions: This study provides new insights into the inter-related utilization of colonoscopy, FOBT, and patient education in Germany, and may be particularly informative for the design of strategies to increase CRC screening uptake. It indicates that sex differences in CRC screening test use could result to a large extent from general visits to different types of specialist physicians involved in the CRC screening process.