Patients in the U.S. are not required to have a gastroenterology office visit before they have a colonoscopy. However, according to a recent study published by JAMA, almost three in 10 patients still have such a visit.

Kevin R. Riggs, MD, of Johns Hopkins University School of Medicine, and colleagues noted that the costs associated with colonoscopies has been scrutinized for being too high.

“Unnecessary colonoscopies contribute to societal costs, and the cost per procedure is high,” the authors wrote. “For example, anesthesiologists or nurse anesthetists often administer sedation for endoscopies in low-risk patients, adding more than $1 billion of potentially unnecessary costs annually.”

Riggs et al. examined patient data from 2010 to 2013 for more than 842,000 patients between the ages of 50 and 64 who had outpatient colonoscopies performed in the gastroenterology setting, including a diagnosis for screening or polyp surveillance. Each patient had continuous insurance coverage for a full year before the procedure.

Overall, the team found that 29 percent of the patients they researched had a precolonoscopy office visit. The mean payment for office visits was more than $123.

Another noteworthy statistic from the data was the percentage of patients from the South. Of the patients who had an office visit before their colonoscopy, 50.5 percent were from southern states. Of the patients who had no office visit, that number was approximately 31 percent.

Looking at the data, the authors concluded that the individual cost of these visits may not be all that significant, but the cost on society adds up when one considers the high volume of colonoscopies performed each year.

“There are an estimated 7 million screening colonoscopies performed in the United States annually, so the cumulative costs are significant,” the authors wrote. “Identifying which patients benefit from a precolonoscopy office visit and targeting those patients could increase the value of colon cancer screening.”

Riggs and colleagues noted some limitations of their study. First, the team was unable to know “the exact circumstances” of each and every office visit, so some may have been specifically requested by either the patient or the referring clinician. Second, since only patients younger than 65 years old were considered for the study, these findings can’t be used to make any statements about older patients.