Breast imaging patients see out-of-pocket costs increase

2020 03 04 22 35 5609 Patient Woman Stressed 400

Out-of-pocket costs for additional breast imaging after screening in the U.S. have nearly doubled since 2010, with women facing unexpected financial consequences as a result, according to research published August 17 in JAMA Network Open.

A group of researchers led by Dr. Kathryn Lowry from the University of Washington in Seattle found that higher out-of-pocket costs coincide with the rapid rise in high-deductible healthcare plans.

"These findings are concerning because women who undergo screening may not be anticipating the costs for additional workup," Lowry told

The Affordable Care Act (ACA) eliminated out-of-pocket costs for nearly all women who undergo screening mammography. However, the ACA's rules don't extend to additional breast imaging, which occurs after greater than 10% of screening examinations, the study authors said.

Lowry added that it is not surprising that out-of-pocket costs have increased in recent years and that other studies have shown enrollment in high-deductible healthcare plans increasing in recent years, which has "likely" contributed to the rise in costs to patients.

"I think there may be less awareness about the magnitude of these costs, for example, that in recent years over 25% of women who had additional imaging and biopsy had out-of-pocket costs exceeding $400," she said.

Lowry's team wanted to look at trends in out-of-pocket costs for commercially insured women who underwent additional breast imaging evaluations or procedures after screening mammography.

The researchers looked at 325,900 women from 2010 to 2017 with 418,378 additional breast imaging examinations or procedures. The women were aged 40 to 64 years and were enrolled in employer-based healthcare plans. They also underwent screening mammography and additional breast imaging examinations or procedures within 11 months of the screening mammogram.

They found that out-of-pocket costs varied across women and the type of imaging received and generally increased over time.

Change in out-of-pocket costs for additional breast imaging services
Imaging type 2010 2017
Screening mammography + diagnostic mammography + ultrasound $0 $23.44
Screening mammography + MRI $24.49 $47.50
Screening mammography + diagnostic mammography + ultrasound + biopsy $94.60 $170.80
Any imaging with biopsy $91.14 $151.95
All pathways $24.49 $47.50

Cost sharing also increased throughout the study period. For example, the median percentage of costs shared increased from 0% to 7.5% for women receiving screening mammography plus diagnostic mammography plus ultrasound. Women who received screening and diagnostic mammography, ultrasound, and biopsy, meanwhile, saw their median percentage of costs shared increase from 9.6% to 18.2% of the total costs.

Out-of-pocket costs for related care such as office visits and pathology expenses were not included in the study, which researchers said may underestimate total patient contributions.

The team wrote that consumer cost-sharing is associated with decreased use of evidence-based medical care, saying that it is possible that higher cost-sharing could deter women from undergoing diagnostic evaluation following screening mammography. This in turn undermines the goal of the ACA to remove barriers to screening, the researchers said.

Lowry told these results suggest that there is a need to revisit the design of health insurance plans with a goal of reducing or eliminating these out-of-pocket costs to ensure that screening participation does not have unanticipated financial consequences.

"More research is needed to evaluate the impact of these costs on delays in care as well as future screening participation," she said.

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