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Men with prostate cancer willing to pay more for advanced biopsies
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Men with prostate cancer paid up to $2,000 out of health savings accounts for magnetic resonance imaging–transrectal ultrasound fusion–guided prostate biopsies, according to an analysis published in Urology Practice.
“We have increasingly observed that some insurance companies are not covering prostate magnetic resonance imaging–transrectal ultrasound fusion biopsies and that some patients are paying out of pocket for these biopsies because they have a health savings account or high deductible coverage,” Chad Ellimoottil, MD, MS, assistant professor of urologic health services in the Dow Health Services Research division at University of Michigan, told HemOnc Today. “The purpose of the study was to understand how much patients would be willing to spend from a health savings account for a biopsy intervention with attributes similar to prostate magnetic resonance imaging–transrectal ultrasound fusion biopsies.”
Over the last 10 years, the number of employers offering health care savings accounts has grown tenfold, and approximately 1 million individuals start a new account each year. The Employee Benefit Research Institute estimates $2,000 is the average amount individuals have in health care savings accounts.
Researchers enrolled 202 patients and performed 36 attribute surveys and 20 semi-structured interviews, results from which were used to inform the decisions in 146 conjoint surveys. Researchers designed the conjoint surveys as full profiles tasks that used three clinical attributes and one cost attribute. Patients selected from two options they preferred based on the attribute levels presented to them, but also could select an opt-out option.
The most common age group of men who participated in the conjoint survey was 61 to 65 years (38.4%; range, 18-70).
Eighty-two men (56.2%) had a history of prostate biopsy and 49 men (59.8%) tested positive for cancer — 77.6% (n = 38) of whom received treatment. Additionally, 63% (n = 92) had private insurance.
Based on having $2,000 in a health care savings account, surveys asked men if they would be willing to pay more for a magnetic resonance imaging–transrectal ultrasound (MR-US) prostate biopsy — which fuses MRI scans with ultrasound imaging to create a detailed 3-D view of the prostate — than they would for a transrectal ultrasound-guided (TRUS) prostate biopsy, which costs between $700 and $1,570 less than a MR-US, depending on the institution.
On average, patients appeared willing to pay $1,597.80 more for a biopsy intervention that improved the chance any cancer would be detected from 43% to 51%. Further, they would pay $2,034.40 more for a biopsy that improved from 70% to 90% the chance of a negative reading truly reflecting no cancer.
Patients were unwilling to pay more for a biopsy that improved the chance of detecting high-risk cancer alone from 24% to 33%.
“Our findings provide insight for many stakeholders,” Ellimoottil said. “For payers, the finding that patients would be willing to pay $1,500 to $2,000 for benefits of a biopsy intervention that is similar to prostate MR-US biopsy reveals that patients place high value on this new technology.”
Limitations of the study included its hypothetical methodology and that participants did not actually provide money for health care services, researchers noted, adding the relationship between willingness to pay and experience with prostate cancer detection remains unclear.
“This is important information for payers who do not reimburse for prostate MR-US biopsy,” Ellimoottil said. “For physicians, the same finding can help frame conversations as patients and physicians engage in shared decision making about the use of prostate MR-US biopsy. The value placed on MR-US biopsy is particularly useful when urologists are counseling patients with a health savings account and/or patients whose insurance does not cover prostate fusion biopsy.”
Moving forward, researchers noted a need to know how much patients would be willing to pay if they did not contribute to health savings accounts.
“An enhanced understanding of patient preferences and the monetary value they place on these preferences, will be imperative to understand as healthcare delivery rapidly moves toward a consumer-driven era,” Ellimoottil said. – by Chuck Gormley
Reference:
Helmchen LA, et al. Health Aff (Millwood). 2015;doi:10.1377/hlthaff.2015.0480.
For more information:
Chad Ellimoottil, MD, MS, can be reached at Center for Health Outcomes and Policy, University of Michigan, 2800 Plymouth Road, Bldg 16, 1st Floor, Room 100S, Ann Arbor, MI 48109-2800.
Disclosure: The researchers report no relevant financial disclosures.
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