Out-of-pocket costs may block women from breast MRI

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The threat of out-of-pocket costs from breast MRI may negatively affect women at greater risk of breast cancer, blocking their access to needed care, according to a study published July 28 in the Journal of the National Cancer Institute.

The study findings stress the need for better financial support for additional imaging beyond screening mammography, especially for women with high-deductible insurance plans, wrote a team led by I-Wen Pan, PhD, of MD Anderson Cancer Center in Houston.

"[For women at higher risk of breast cancer] ... early initiation of annual breast cancer screening with MRI might reduce breast cancer mortality by half or more," the group noted. "Research has found cost to be a major barrier to this screening modality among [a] high-risk population; thus, out-of-pocket costs of breast MRI may negatively impact the longevity of these women."

Although many women carry health insurance that does cover breast MRI, there are also many who don't, according to the researchers. And coverage such as that offered by the Affordable Care Act's (ACA) preventative care provision doesn't apply to breast MRI for screening. Since the cost of breast MRI can be five to 10 times higher than screening mammography, women may face out-of-pocket charges that keep screening MRI out of reach.

Pan and colleagues sought to assess these expenses and the proportion of women who are burdened with these charges. They used data from the IBM Marketscan Research database for 16,341 women who underwent breast MRI between 2009 and 2017 and had screening mammography within six months of the MRI exam. The researchers assessed women's out-of-pocket costs as the sum of copayment, coinsurance, and deductible and calculated zero cost-sharing rates. The Marketscan database collects information on the type of health insurance plans, categorizing them by level of deductible; of the study cohort, 11% had high-deductible insurance plans.

Over the study time frame, the percentage of women with no out-of-pocket costs for screening mammography increased from 81.9% in 2009 to 96.8% in 2017 (after ACA implementation). But the same was not true for breast MRI: Pan's group found that the percentage of women with no out-of-pocket costs for breast MRI decreased over the study time period, from 43.1% in 2009 to 26.2% in 2017.

Furthermore, adjusted mean out-of-pocket cost for women with high-deductible insurance plans was twice that of their lower deductible counterparts, at $549 compared with $251. The authors also found that Southern women were more likely to have out-of-pocket costs for screening breast MRI and that these costs were higher than women in other parts of the U.S.

Action is needed to make breast MRI more financially accessible to women who need it, according to the authors.

"The rising trend of high-deductible plan enrollment suggests that, without policy actions to extend the prevention provision of the ACA to individuals at high risk for cancers, more women are likely to experience financial burden from screening MRI in the future," they concluded.

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