July 16, 2024
Out-of-pocket medical costs are substantial & rising for men whose abnormal prostate cancer screenings require further testing
Findings align with a recent American Cancer Society statement urging payers to eliminate costs that may keep patients from undergoing diagnostic tests following prostate cancer screening
Adapted from Wiley/CANCER
Prostate-specific antigen, or PSA, screening aims to identify men who may harbor potentially lethal prostate cancer, and those with high PSA results often require more extensive (and expensive) diagnostic testing to establish a diagnosis.
New research led by University of Michigan Medical School researchers reveals that the out-of-pocket costs for such additional tests are substantial, common, and rising.
The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.
Abnormal screening tests, such as elevated PSA, warrant additional testing involving magnetic resonance imaging and/or prostate biopsies. High out-of-pocket costs for these tests—including copayment, coinsurance, and deductibles—may not only place a substantial burden on patients, but also may deter patients from going through with recommended screening.
To investigate the extent of such financial burdens, researchers analyzed information on 3,075,841 privately insured men in the United States, ages 55 to 69, who underwent PSA screening in 2010 through 2020. Among these men, 91,850 had a second PSA test and an elevated PSA, of which 40,329 (43.9%) underwent subsequent diagnostic testing.
Among the men who underwent subsequent testing, more than 75% experienced out-of-pocket costs. The median out-of-pocket costs rose substantially over the years of the study for patients undergoing biopsy only (from $79 in 2010 to $214 in 2020), imaging only ($81 to $490), and imaging plus biopsy ($353 to $620).
In 2023, the American Cancer Society published a statement asserting that cancer screening is a multistep process, stressing that payers must eliminate out-of-pocket costs for all necessary diagnostic tests.
“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, M.D., M.P.H., a urology fellow at U-M Health and researcher at Michigan Medicine, U-M's academic medical center. “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.”
This study was led by Srivastava and A. Mark Fendrick, M.D., director of U-M's Center for Value-Based Insurance Design, along with co-authors Anca Tilea andVanessa K. Dalton, M.D., M.P.H.. of U-M and David D. Kim, Ph.D. of the University of Chicago.
Srivastava is part of the T32 Urologic Oncology Fellowship in the U-M Department of Urology.
“Out-of-Pocket Costs for Diagnostic Testing Following Abnormal Prostate Cancer Screening Among Privately Insured Men.” Arnav Srivastava, Anca Tilea, David D. Kim, Vanessa K. Dalton, and A. Mark Fendrick. CANCER; Published Online: July 15, 2024 (DOI: 10.1002/cncr.35392)
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