Monday, February 10, 2014

PillCam Approved: Will This Help Treating Inflammatory Bowel Disease and Save Billions in Healthcare Costs?

PillCam for colonoscopy testing

So the past week the FDA approved the use of PillCam (mind you it is approved to be used in 80 other countries already-the FDA seems slow at this). Note that more than over 1.5 million patients have used this and the FDA is just now getting around to approving it. Colonoscopies can be pretty expensive and as this New York Times article points out can vary depending on where you are in the United States by thousands of dollars. The average price for a colonoscopy in the United States is $1,185 however in Switzerland is only $655.

Given Imaging is the company that makes the PillCam.  The camera is battery operated and takes pictures for about 8 hours and then sends those pictures to a doctor. The patient wears a recording device about their waist. The company has been producing the PillCamera since 2001. One drawback are the images are not as great as an actual colonoscopy. Also if you actually do have a polyp the doctor then has to go in via colonoscopy and get rid of the polyp. However, there are patients who can't complete a colonoscopy (anatomy, previous surgeries, colon diseases, etc). which is about 750,000 people. The PillCam is only $500 which is much less than $4,000 for a typical colonoscopy (an 88% decrease in cost). According to estimates there were about 14.2 million colonoscopies performed in 2002. So just by sheer growth that number is much greater than that today. Now if you had a few million people take the PillCam instead of a traditional colonoscopy you could start saving billions of dollars in healthcare costs.

The company does make a pill camera just for Crohn's which is PillCam SB (Small Bowel). According to the company 75% of Crohn's patients have legions in their small bowel. What is even more interesting is that 62% of Crohn's patients changed their therapy within 3 months of using the PillCamera. The procedure is pretty easy. It requires patients just fast the night before and then you go to the doctor's office and wear a belt around your waist over your clothing, swallow the pill with a tall glass of water, then come back to the doctor's office after the images are sent. The PillCam passes through the bowel movement within 24-72 hours after you ingest it. There are of course risks which are very small (less than 2%) however for Crohn's the risk of retention with the PillCam is 5% (I would imagine if you had a stricture). Since Crohn's and ulcerative colitis patients in general have complications the PillCam might be something that could supplement a traditional colonoscopy. GI's could give monitor Crohn's or ulcerative colitis every couple of years (with a lot less hassle of having to do the nasty prep-honestly the prep for the colonoscopy isn't bad I have had 3 since 2011 and my advice is to start the prep as early as you can).

No question over time the technology will improve, the images will get better, the pills smaller, and the complications will get reduced. Gastroenterologists will have to do fewer colonoscopies which would mean more time to spend with patients. However, gastroenterologists may not be happy if a pill camera is able to replace a job that they do. GI's are some of the highest paid doctors making on average over $340,000 per year and 4% make $750,000 or more (I would assume these are researchers, administrators, or they own a practice). Gastro doctors have to spend 4 years in medical school, 3 years of internal medicine residency, then 2-3 years of a fellowship. My GI for example graduated medical school in 1984 then did a one year internship then 2 year internal medicine residency, then 2 year fellowship for gastroenterology (ending his fellowship in 1989-so 5 years total after medical school). So essentially gastroenterologist go to school or have training for almost a decade after they graduate college! No question though that the PillCam will be an added improvement, potential to save billions in healthcare costs, increase monitoring of Crohn's and ulcerative colitis and most importantly may spare many people the process of having to do the prep the night before!

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