Prostate patients willing to pay more for high-sensitivity biopsy guidance

As long as they’ve got money in a health savings account (HSA), men are willing to pay considerably more to choose prostate biopsy guided by MRI plus transrectal ultrasound over prostate biopsy guided by transrectal ultrasound alone, according to a study published online in Urology Practice.

Researchers from the University of Michigan and Loyola University Chicago enrolled 202 men aged 55 to 70 from a general urology clinic, according to the study report. The team surveyed and interviewed the participants, asking them to choose between the two hypothetical image-guided biopsy interventions based on attributes commonly used to compare the two.

On analysis, the researchers found patients were willing to pay $1,598 more out of pocket for a biopsy intervention with a boost in all-cancer-detection sensitivity from 43 to 51 percent, which MRI-ultrasound fusion biopsy guidance would offer.

In addition, the patients were willing to shell out $2,034 more for a negative predictive value improvement from 70 percent to 90 percent—and unwilling to pay extra for an intervention with only improved sensitivity to find high-risk cancers.

In their discussion, lead author Chad Ellimoottil, MD, MS, of the University of Michigan and colleagues suggest their findings may have ramifications for various stakeholders.

“For payors, the finding that patients would be willing to pay $1,500 to $2,000 for benefits of a biopsy intervention that is similar to MRI-ultrasound prostate biopsy reveals that patients highly value this new technology,” they write. “This is important information for payors who do not reimburse for MRI-ultrasound.”

For physicians, the authors point out, the same finding can help share informed decision-making with patients.

Meanwhile, they note, their finding that patients are not willing to pay extra for a biopsy strategy that ups the chances of catching only high-risk prostate cancer “is relevant when counseling patients, because the improved detection of clinically significant prostate cancer is one of the touted benefits of MRI-ultrasound prostate biopsy.”

Among the limitations the authors acknowledge in their study’s design are its reliance on hypothetical situations—no actual money changed hands—and its use of HSA scenarios.

“Moving forward,” they write, “research in this area should focus on understanding how much patients would be willing to pay if they did not have a pre-funded HSA and how much patients would be willing to pay for the use of MRI-ultrasound prostate biopsy to confirm active surveillance eligibility.”