Examining Patient Willingness to Pay for Magnetic Resonance Imaging Guided Prostate Biopsy: Implications in the Era of Health Savings Accounts

Chad Ellimoottil, Marissa Marcotte, Daniel Grace, Alexander Krasnikov, Joan M. Phillips, Marcus L. Quek, Robert Flanigan, Gopal N. Gupta

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Introduction: The proliferation of health savings accounts has empowered patients to participate in medical decisions through a direct financial incentive. Using conjoint analysis we examined how much extra patients with a health savings account would be willing to pay for magnetic resonance imaging-transrectal ultrasound fusion guided prostate biopsy over transrectal ultrasound guided prostate biopsy. Methods: We enrolled men who were 55 to 70 years old from a general urology clinic. We performed a literature review, distributed surveys and conducted semi-structured interviews to develop and rank attributes commonly used to compare magnetic resonance-ultrasound to transrectal ultrasound guided prostate biopsy. Using conjoint surveys we asked participants to select their preferred choice between 2 hypothetical biopsy interventions with differing levels of the attributes and cost. Results of the conjoint surveys were analyzed using a multinomial probit model. We performed a sensitivity analysis to assess the stability of our results after adjusting for age, history of prostate cancer, race, education, marital status, income and Zip Code of residence. Results: Patients were willing to pay $1,598 more for a biopsy intervention with increased sensitivity to detect all cancer from 43% to 51% and $2,034 more for a negative predictive value improvement from 70% to 90%. Patients were not willing to pay extra for an intervention with improved sensitivity to detect high risk cancer alone. These estimates did not change with our sensitivity analysis. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)85-92
Number of pages8
JournalUrology Practice
Volume5
Issue number2
DOIs
StatePublished - Mar 2018
Externally publishedYes

Keywords

  • biopsy
  • cost-benefit analysis
  • diagnostic imaging
  • patient preference
  • prostate

ASJC Scopus subject areas

  • Urology

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