Men at risk for prostate cancer could be forgoing necessary imaging due to climbing out-of-pocket costs
More than three-fourths of men who are told they have elevated prostate specific antigen levels are saddled with extra out-of-pocket costs to undergo additional testing.
This is something that could prevent many from pursuing the additional diagnostic exams required to get an accurate diagnosis and subsequent treatment, caution the authors of a new analysis published in the online journal Cancer.
Additional testing after elevated PSA levels are discovered include biopsy, imaging (PET, MRI) or a combination of both. For this analysis, experts focused specifically on the OOP costs of biopsies and MRI exams.
To do this, they examined data on privately insured men ages 55-69 who underwent PSA screening between 2010 and 2020, resulting in over 3 million men total. Of those, 91,850 had a second PSA test and/or elevated PSA levels, 40,329 (43%) of whom underwent additional diagnostic exams.
OOP costs were common for the group of men who completed additional workups, with more than 75% having to pay varying amounts for the exams. The median costs increased substantially throughout the timeframe studied.
On average, those who underwent biopsy alone paid between $79 and $214; MRI alone resulted in OOP costs ranging from $81 to $409, and MRI plus biopsy costs spanned $353 to $620 over the 10-year period.
Authors of the study said that their findings underscore the need to eliminate cost-sharing for screening related to prostate cancer.
“In the context of prostate cancer, this means that insurance companies should provide full coverage for imaging, prostate biopsy, and other recommended testing, if indicated by an abnormal prostate cancer screening test,” said lead author Arnav Srivastava, MD, MPH, of the University of Michigan, Ann Arbor. “We have seen this strategy successfully implemented in colorectal cancer screening, as part of a new addition to the Affordable Care Act. Thus, we recommend that policymakers and insurance companies offer full coverage for testing throughout the screening pathway and eliminate cost-sharing for patients.”
The study abstract can be found here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.