Mp57-02 Out-of-Pocket Costs Downstream of Prostate Cancer Screening Among Privately Insured Men

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes II (MP57) 1 May 2024MP57-02 OUT-OF-POCKET COSTS DOWNSTREAM OF PROSTATE CANCER SCREENING AMONG PRIVATELY INSURED MEN Arnav Srivastava, Anca Tilea, David Kim, Vanessa K. Dalton, and A. Mark Fendrick Arnav SrivastavaArnav Srivastava, Anca TileaAnca Tilea, David KimDavid Kim, Vanessa K. DaltonVanessa K. Dalton, and A. Mark FendrickA. Mark Fendrick View All Author Informationhttps: //doi. org/10. 1097/01. JU. 0001009420. 83948. eb. 02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Most patients face minimal, if any, out-of-pocket costs (OOPC) during initial prostate cancer screening. However, the downstream OOPC of prostate biopsy and MRI incurred by initial screening remain poorly characterized. These costs may create financial barriers to the many patients screened annually for prostate cancer and hinder their ability to receive necessary follow-up testing. METHODS: We identified men ages 55-69 who underwent prostate cancer screening with PSA testing from 2009-2020 from the Truven Marketscan database. Only patients with 12 months of follow-up and continuous enrollment in their insurance plan were included. From the initial date of screening, we identified those patients receiving prostate biopsy or MRI within 12 months. We calculated the median OOPC, summating copayment, coinsurance, and deductibles. OOPC and its components were tabulated over time, adjusting for inflation. RESULTS: We identified 4, 527, 436 patients who underwent prostate cancer screening, of which 2. 8% (N=128, 268) underwent prostate biopsy and 1. 3% (N=57, 691) underwent MRI. The percentage of patients undergoing biopsy declined from 3. 4% in 2009 to 2. 3% in 2020. Conversely, the percentage of patients receiving an MRI increased from 0. 9% to 2. 2% from 2009-2020. OOPC for both procedures increased during the study period, mostly driven by deductible increases. Median prostate biopsy OOPC increased from 88. 79 to 173. 21 from 2009-2020 (Figure 1). OOPC for MRI increased from 54. 15 to 202. 90 over the same period (Figure 2). CONCLUSIONS: The failure to follow-up a positive cancer screening test undermines the screening process. Patients receiving prostate biopsy and / or MRI following prostate cancer screening may incur nearly 400 in OOPC. This substantial and increasing amount of cost sharing may preclude patients from completing the screening process with the requisite follow-up testing. Public and private payers should align benefits to reduce, if not eliminate, cost sharing for follow-up procedures associated with positive initial screening tests. Download PPTDownload PPT Source of Funding: Arnav Srivastava is supported by a training grant from the National Cancer Institute: T32CA180984 © 2024 by American Urological Association Education and Research, Inc. FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e936 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc. Metrics Author Information Arnav Srivastava More articles by this author Anca Tilea More articles by this author David Kim More articles by this author Vanessa K. Dalton More articles by this author A. Mark Fendrick More articles by this author Expand All Advertisement PDF downloadLoading. . .