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Out-of-Pocket Costs for MRI Breast Cancer Screening Hitting More Women

(Reuters Health) — Increasing numbers of women who need MRI screening for breast cancer are being hit by high out-of-pocket costs, a new study finds.

An analysis of data from 16,341 women who had a screening MRI between 2009 and 2017 found the proportion who had a zero cost-share decreased from 43.1% to 26.2%, according to the report published in the Journal of the National Cancer Institute.

“The Affordable Care Act is designed to improve cancer prevention as well as other preventive services,” said study co-author Ya-Chen Tina Shih, a professor of health economics and chief of the section of cancer economics and policy at the University of Texas MD Anderson Cancer Center in Houston. “If something is recommended by the US Preventive Services Task Force, then insurance companies wave cost sharing requirements.”

Unfortunately, Shih said, “MRI plus mammography as a screen for high-risk women hasn’t been discussed by the USPSTF. This is a group of women we really want to protect and make sure they get the screening they need. Because the ACA protections are connected to the task force’s recommendations, this population isn’t covered yet.”

In hopes of spurring the task force to review data supporting MRI for screening in high-risk women, Shih and her colleagues decided to look at the out-of-pocket costs these women were paying. The researchers turned to the 2008-2017 IBM MarketScan Research Databases, which contain de-identified claims from large employers and health plans across the US that provide private healthcare coverage for employees, their spouses, and dependents. The data include enrollment records and health insurance claims of inpatient services, outpatient visits, and outpatient prescription drugs.

In their analysis, the researchers dichotomized insurance plans into high-deductible (HD) and non-HD plans.

Overall, the study found that among women with breast MRI for screening purposes during the study period, 36.3% had zero cost-share; 11% had HD insurance plans and nearly half were 50 years of age and older. The average out-of-pocket cost per breast MRI was $282.

For screening mammography, the proportion of women with zero cost-share increased over time: 81.9% in 2009, 91.3% in 2011 (immediately after ACA enactment), and 96.8% in 2017. The opposite trend was observed for breast MRI. The proportion of women with zero cost-share was 43.1% in 2009, 38.5% in 2011, and 26.2% in 2017.

Women with HD plans were less likely to have a zero cost-share, as were women who lived in non-metropolitan areas. In addition, after ACA enactment, women were less likely to have zero cost-share for screening MRI in most census divisions except the South Atlantic and Mountain areas. In the New England and Pacific divisions, over 36.3% of women who underwent screening MRI paid zero out of pocket for their MRI. Meanwhile, among census divisions with less generous coverage in the post-ACA era, mostly in the South region and the Mountain division, less than 30% of women paid zero out of pocket cost for the screening MRI.

The researchers have found “some concerning trends,” said Elena Elkin, a professor of health policy and management at the Columbia University Mailman School of Public Health in New York City. “The reason it’s particularly concerning is that prior studies, conducted mostly before provisions of the ACA were in effect, showed that even small amounts of cost sharing, $10, $20, for example, could be a deterrent to women getting screening mammography.”

The new study shows that the median out of pocket payment is almost $300, Elkin said. “There’s a real concern that this would be a deterrent for appropriate effective screening for women who would benefit from a screening MRI,” she added.

“No one is advocating for all women to get screening MRI,” Elkin said. “But this is a case where there is a real health benefit for some women.”

What’s particularly worrisome, Elkin said, is that this study is only looking at women who got the screening MRI. We don’t know how many women felt they couldn’t get it because of the high out-of-pocket cost, she added.

SOURCE: Journal of the National Cancer Institute, online July 28, 2021.

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