A recent report in Urology Practice makes what we see as a somewhat odd statement about what patients may be willing to pay for an MRI/TRUS fusion-guided biopsy as opposed to a TRUS-guided prostate biopsy.
The authors of this article set out to discover (on a theoretical basis) exactly how much men “with a health savings account” here in the USA would be willing to pay from that health savings account in order to have an MRI/TRUS fusion-guided biopsy as opposed to a simple TRUS-guided biopsy for risk of prostate cancer if the MRI/TRUS biopsy wasn’t covered by their standard health insurance package.
The statement reads as follows:
Our findings suggest that patients are willing to pay approximately $1,500 to $2,000 from a health savings account for a biopsy intervention with a benefit profile similar to that of magnetic resonance-ultrasound guided prostate biopsy.
Clearly, therefore, this study only applies to men here in the US. Furthermore, it only applies to that percentage of men with healthcare insurance in the US who actually have a health savings account. And it would probably also depend on the precise nature of that health savings account.
As of January 2016, a survey conducted by America’s Health Insurance Plans (AHIP) of U.S. health insurance companies offering health savings account/high-deductible health plans (HSA/HDHPs), indicated that about 20.2 million Americans were enrolled in such plans (i.e., about 6 percent of the US population).
There are also going to be a small but not insignificant number of American males who could afford to pay up to about $2,000 out of their own pockets for such a biopsy too. If that amounted to another 4 percent of the US male population, your sitemaster would be surprised.
We should remember that (as of November 2015) a study by the Pew Charitable Trusts reported that one in three American families have no savings at all. And (in December 2015), another study found that 56.3 percent of Americans had < $1,000 in their checking and savings accounts combined.
The bottom line is that most Americans of 50 years or more almost certainly don’t have a health savings account and they also don’t have a spare $1,500 to $2,000 in a bank account (or under the mattress, or anywhere else) to pay for this type of expense.
The “New” Prostate Cancer InfoLink would also point out that, at least at present, there are few good data to suggest that an MRI/TRUS-guided biopsy alone provides a high level of diagnostic accuracy (as compared to a 12-core systematic biopsy combined with an MRI/TRUS-guided biopsy).
Thus, the actual costs for the average patient seeking a first-line biopsy would actually include:
- The costs for the initial MRI
- The costs for the evaluation of the results of that MRI (as evaluated by an experienced and skilled uroradiologist)
- The costs for the systematic, 12-core, TRUS-guided biopsy, and
- The costs for the MRI/TRUS fusion-guided biopsy
If we assume that the costs of the systematic,12-core, TRUS-guided biopsy is covered by most insurance companies, this still means that the patient has to find the money to cover the costs of the original MRI; the costs for the skilled evaluation of that MRI; and the costs for the actual, targeted, MRI-guided component of the MRI/TRUS fusion-guided biopsy. Somehow we suspect that the costs for these three elements combined would be significantly north of $1,500 to $2,000 at most institutions (whether the patient had a health savings plan or not).
Maybe your sitemaster is misguided … but then he doesn’t have a healthcare savings account!
Filed under: Diagnosis, Living with Prostate Cancer, Risk | Tagged: biopsy, cost, fusion, MRI |
THE "NEW" PROSTATE CANCER INFOLINK 
20.2 million is, however, around 13% of the US workforce. Still small in comparison and does not take away from Sitemaster’s thrust …. albeit probably a more relevant number.
Moreover, in absolute numbers, especially when compared to annual diagnosis of PCa, 20.2 million is considerable.
Dear Rick:
20.2 million is the total number of “covered lives”, not the number of persons in the workforce. At a rough guess, the number of persons in the workforce who have this type of health plan is probably only a quarter to third of that 20.2 million (at most). What is more, this research was done based on people attending a single tertiary care center in Chicago, so it was hardly a representative study population to begin with.
Where does Medicare fit in coverage?
Dear Chuck:
I am not expert on exactly what Medicare does or doesn’t cover in the different Medicare regions around the country. I suspect (but do not know) that Medicare probably covers MRIs and MRI/TRUS-guided biopsies for men who have a rising PSA and a prior negative biopsy. They may also cover first-line MRI/TRUS-guided biopsies for men with particular signs and symptoms who make enough fuss — but this is really not my area of expertise. Maybe someone else has a good answer for your question.