Introduction:

Multiparametric magnetic resonance imaging (MRI) is included in guideline-directed care for prostate cancer screening, diagnosis, and treatment. Data indicate that biparametric MRI (without intravenous contrast) is similarly accurate, although limitations exist. Biparametric MRI is faster, cheaper, and avoids the potential for contrast related side effects. This study examines out-of-pocket costs associated with prostate MRIs.

Methods:

We compared costs between CPT 72195 (MRI Prostate without contrast) and CPT 72197 (MRI Prostate with contrast) based on 2021 payment data. Medicare cost data was accessed from the Medicare Part B Dashboard. Out-of-pocket (OOP) costs were extrapolated based on standard Medicare Part B co-payment rate of 20%. Negotiated prices among patients with commercial insurance were accessed from Turquoise Health, a national dataset including rates from over 5,700 hospitals.

Results:

Medicare pays approximately $389 for a prostate MRI with contrast compared to $263 without contrast. In 2021, 265,000 prostate MRIs with contrast were performed for patients insured by Medicare. Converting all of these to non-contrast MRI would therefore decrease Medicare spending by up to $30 million. Using a co-payment rate of 20%, OOP costs for patients insured by Medicare would decrease from $77 to $52 per MRI. The median price for MRI with contrast for patients with commercial insurance is $2,295 compared to $1,472 for MRI without contrast. OOP costs for patients with commercial insurance could decrease from $459 to $295 per MRI.

Conclusion:

Biparametric MRI could reduce the financial toxicity of prostate cancer screening and improve access to care for patients with limited resources. OOP savings are higher for patients with commercial insurance compared to Medicare. In settings where biparametric MRI and multiparametric MRI offer similar accuracy, biparametric should be preferred to alleviate the financial toxicity of prostate cancer care. These findings have significant implications for patients younger than 65 who are not eligible for Medicare and may end up requiring multiple MRIs in their lifetime as part of active surveillance protocols.

Funding: N/A