Utilization Trends of Colorectal Endoscopic Submucosal Dissection Following Reimbursement Revision and During the COVID-19 Pandemic: An Interrupted Time-Series Analysis Using a Large Japanese Claims Database.

PURPOSE: Colorectal endoscopic submucosal dissection (ESD) is an essential oncological procedure with challenging optimal resource allocation. A 2018 reimbursement revision in Japan restricted ESD coverage to early colorectal cancer and neuroendocrine tumors. We aimed to describe utilization trends of ESD, endoscopic resection (ER), and diagnostic colonoscopy following this revision, and evaluate real-world endoscopic triage during the early stages of the COVID-19 pandemic.

METHODS

Using a large Japanese claims database, we performed an interrupted time-series analysis assessing utilization changes in ESD, ER (stratified into < 2 cm and ≥ 2 cm), and colonoscopy following the 2018 revision and COVID-19 pandemic onset (April 2020).

RESULTS

Following the 2018 revision, ESD showed an immediate 31% decline (incidence rate ratio [IRR] 0.69, 95% confidence interval [CI] 0.58-0.81). ER < 2 cm increased by 5% (IRR 1.05, 95%CI 1.03-1.06) and ER ≥ 2 cm increased by 13% (IRR 1.13, 95%CI 1.02-1.24), while diagnostic colonoscopy remained stable. When the COVID-19 pandemic began, ESD showed a non-significant decrease (IRR 0.89, 95%CI 0.74-1.06). Counterfactual analysis revealed suppression of ER < 2 cm (- 23.8%), ER ≥ 2 cm (- 25.0%), and diagnostic colonoscopy (- 27.4%) during April-July 2020, whereas ESD deviated minimally (- 5.8%).

CONCLUSION

The 2018 revision was followed by decreased ESD and increased ER utilization. During the early stages of the pandemic, ER and colonoscopy fell markedly below projected trends, whereas ESD deviated minimally. These findings quantitatively document changes in procedure utilization consistent with endoscopic triage, suggesting that advanced oncological procedures were relatively prioritized and preserved during these severe system disruptions.