Medicare Reimbursements Following Confirmatory MRI-Guided Biopsy vs. Systematic Biopsy Only in Low-Risk and Favorable Intermediate-Risk Prostate Cancer: A Real-World Cost Analysis Among Elderly Medicare Beneficiaries
Author(s)
Bernard Bright K. Davies-Teye, MD, MPH, PhD1, Eberechukwu Onukwugha, MSc, PhD1, M. Minhaj Siddiqui, MD, FACS2, Julia F. Slejko, MS, PhD1, Zafar Zafari, PhD1, C. Daniel Mullins, PhD1.
1Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA, 2University of Maryland School of Medicine, Baltimore, MD, USA.
1Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA, 2University of Maryland School of Medicine, Baltimore, MD, USA.
OBJECTIVES: In the United States (US), the annual Medicare spending on localized prostate cancer was $400 million from 2004 to 2007, and increasing over time. Prostate biopsy-related costs are a major contributor to this expenditure. Despite this, the economic implications of incorporating magnetic resonance imaging-guided biopsy (MRI-Bx) into confirmatory diagnosis algorithms of low-risk and favorable intermediate-risk prostate cancer (LIPCa) remains understudied. This study quantified the reimbursed Medicare costs (RMC) associated with MRI-Bx in the elderly Medicare population.
METHODS: We conducted a retrospective cohort study utilizing SEER-Medicare data (2006-2020) linked to PolicyMap Census tract-level social determinants of health measures. We identified patients with incident LIPCa who received MRI-Bx or systematic biopsy-only (SBx) and who initiated active surveillance or radical treatment using procedure or ICD-9/10-CM billing codes. We ascertained patient-level covariates in the 12-month baseline period, contextual factors at diagnosis, and implemented Propensity Score inverse probability of treatment weighting to account for differences in measured covariates between groups. We estimated the 12-month total RMC inflated to 2024 US dollars, cost ratio, and average marginal effect (AME) using weighted generalized estimating equations. Sensitivity analyses quantified 18-month reimbursements, and E-values.
RESULTS: Among 8,620 patients, 15.3% received MRI-Bx. The 12-month RMC was 11.4% higher in the MRI-Bx group (adjusted cost ratio=1.114; 95% CI=1.051 to 1.181; p-value<0.01), with AME of $3,588 (95% CI=$1,556 to $5,619; p-value<0.01). Physician and supplier (MRI-Bx: 42.0% vs. SBx: 46.1%), hospital outpatient (37.0% vs 29.6%), and inpatient hospital (13.6% vs. 16.1%) services contributed the most to RMC. The adjusted mean 18-month RMC difference, and E-value were $4,317 (95% CI=$1,533 to $7,100), and 1.470 (95% CI=1.280 to 1.643), respectively.
CONCLUSIONS: Among elderly Medicare beneficiaries with LIPCa, MRI-Bx was associated with significantly higher Medicare reimbursements. Future studies should assess the long-term clinical and economic value of confirmatory MRI-Bx in this population.
METHODS: We conducted a retrospective cohort study utilizing SEER-Medicare data (2006-2020) linked to PolicyMap Census tract-level social determinants of health measures. We identified patients with incident LIPCa who received MRI-Bx or systematic biopsy-only (SBx) and who initiated active surveillance or radical treatment using procedure or ICD-9/10-CM billing codes. We ascertained patient-level covariates in the 12-month baseline period, contextual factors at diagnosis, and implemented Propensity Score inverse probability of treatment weighting to account for differences in measured covariates between groups. We estimated the 12-month total RMC inflated to 2024 US dollars, cost ratio, and average marginal effect (AME) using weighted generalized estimating equations. Sensitivity analyses quantified 18-month reimbursements, and E-values.
RESULTS: Among 8,620 patients, 15.3% received MRI-Bx. The 12-month RMC was 11.4% higher in the MRI-Bx group (adjusted cost ratio=1.114; 95% CI=1.051 to 1.181; p-value<0.01), with AME of $3,588 (95% CI=$1,556 to $5,619; p-value<0.01). Physician and supplier (MRI-Bx: 42.0% vs. SBx: 46.1%), hospital outpatient (37.0% vs 29.6%), and inpatient hospital (13.6% vs. 16.1%) services contributed the most to RMC. The adjusted mean 18-month RMC difference, and E-value were $4,317 (95% CI=$1,533 to $7,100), and 1.470 (95% CI=1.280 to 1.643), respectively.
CONCLUSIONS: Among elderly Medicare beneficiaries with LIPCa, MRI-Bx was associated with significantly higher Medicare reimbursements. Future studies should assess the long-term clinical and economic value of confirmatory MRI-Bx in this population.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE575
Topic
Economic Evaluation, Medical Technologies, Study Approaches
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology, Reproductive & Sexual Health, Surgery