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Friday, April 28, 2017

Prostate Cancer Patients Would Pay $2,000 for More Accurate Biopsies, Loyola Study Finds

High-Tech Biopsy Combines MRI and Ultrasound

Prostate cancer scan

MAYWOOD, IL –  Prostate cancer patients are willing to pay up to $2,000 of their own money for a new high-tech biopsy technique that significantly improves accuracy, according to a study published in the journal Urology Practice.

The study by senior author Gopal Gupta, MD, and colleagues was a multidisciplinary collaboration among Loyola Medicine and Loyola University Chicago's Quinlan School of Business and Stritch School of Medicine.

Loyola was the first center in Illinois to offer the new technique, called MR-US prostate biopsy. The technique fuses MRI images with ultrasound imaging to create a detailed, 3-D view of the prostate. This improved view helps physicians perform biopsies with much higher precision and increases prostate cancer detection.

When prostate cancer is suspected due to results of a PSA screening test or digital rectal exam, a biopsy is performed. The physician typically sticks a needle into 12 areas of the prostate. However, this traditional method can miss a tumor that’s not located in one of the 12 areas.

In an MR-US biopsy, an MRI is performed before the biopsy to identify lesions that may be tumors. During the biopsy, these MR images are fused with ultrasound imaging, which guides the biopsy needle to the lesions.

Dr. Gupta and his colleagues wanted to better understand how patients perceive this new technology and what they are willing to pay for it. So they partnered with Quinlan School of Business marketing faculty members Joan Phillips, PhD, and Alexander Krasnikov, PhD, to perform a conjoint analysis. (Conjoint analysis is used widely in marketing to understand the trade-offs consumers make when choosing products or services.)

Researchers surveyed 202 men aged 55 to 70 in a urology clinic. The men were asked to imagine they were scheduled to undergo a biopsy for possible prostate cancer, and had $2,000 of their own money in a health savings account. (Such an account allows a patient who has a high-deductible insurance plan to set aside money on a pre-tax basis to pay for medical expenses.)

The patients were willing to pay $1,598 more for a biopsy that increased the likelihood of detecting all types of prostate cancer from 43 percent to 51 percent. (This is similar to the increased sensitivity of an MR-US prostate biopsy.)

The patients were willing to pay $2,034 extra for an exam that, like an MR-US prostate biopsy, increased the negative predictive value from 70 percent to 90 percent. (Negative predictive value is the chance that a negative biopsy truly reflects that there is no cancer.) Patients were not willing to pay extra for a biopsy with improved sensitivity to detect high-risk cancer alone.

Depending on the hospital, MR-US prostate biopsies generally cost $700 to $1,570 more than standard biopsies, and are not covered equally by insurance plans.

“The value placed on MR-US prostate biopsy is particularly useful when urologists are counseling patients with a health savings account and/or patients whose insurance does not cover MR-US prostate biopsy,” Dr. Gupta and colleagues wrote.

Conjoint analysis also can be used to determine patients’ willingness to pay for other new prostate cancer technologies, such as better biomarker screening tests than PSA.

“An enhanced understanding of patient preferences, and the monetary value that they place on these preferences, will be imperative to understand as healthcare delivery rapidly moves towards a consumer-driven era,” researchers concluded.

The study is titled “Examining patients’ willingness to pay for MRI-guided prostate biopsy: Implications in the era of health savings accounts.”

In addition to Drs. Gupta, Phillips and Krasnikov, other co-authors are first author Chad Ellimoottil, MD, MS, a former urology resident at Loyola now at the University of Michigan; Marissa Marcotte, BS, and Daniel Grace, BS, of Loyola University Chicago Stritch School of Medicine, and Marcus L. Quek, MD, and Robert Flanigan, MD, of Loyola Medicine and Loyola University Chicago Stritch School of Medicine. 

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 129,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.