Many patients skip DBT due to out-of-pocket costs

The fear of paying high out-of-pocket costs is leading many patients to decline digital breast tomosynthesis (DBT), according to new findings published by Current Problems in Diagnostic Radiology.

DBT utilization is on the rise throughout the United States, and researchers have observed that it provides numerous benefits to patients. Not all patients agree to undergo such screening, however, and the study’s authors aimed to find out why.

“Research on the challenges of DBT adoption is lacking, particularly from the patient's perspective,” wrote Kellie Chiu, MD, department of diagnostic radiology and nuclear medicine at the University of Maryland Medical Center in Baltimore, and colleagues. “In this study, we aim to identify factors influencing a patient's decision not to utilize DBT in the screening setting.”

Chiu et al. surveyed more than 100 patients seeking care at an academic outpatient breast center in Maryland who declined DBT. During the study period, from February to April 2017, no mandate insurance coverage for the technical fee connected to DBT screening existed in the state of Maryland. This resulted in a potential fee of $50-$100.

No inventive was provided to participate in the survey, which included a total of nine questions. Participants were asked to answer each question using a scale of one to five, with a one representing “strong disagree” and a five representing “strongly agree.” All patients were at least 18 years old, and the average age was 57.3 years old. While 78% of the respondents were black, 18% were white.

So why did these patients decline DBT? The extra costs associated with the examination earned a mean score of 4.67 and a median score of 5. Coming in at No. 2 was a concern about radiation, which had a mean score of 1.73. Anxiety (1.67), concern about compression and/or pain (1.6) and a lack of education about the examination (1.53) were also potential reasons included in the survey. In addition, “May get DBT if there was no extra cost” had a mean score of 4.35 with a median score of 5.

“Studies consistently show that the utilization of health care is price sensitive,” the authors wrote. “Copayment and cost sharing have helped decrease overall healthcare costs while having the unintentional effect of acting as a negative incentive for patients to seek proper preventive care. This is especially true for women with low socioeconomic and educational status.”

The researchers also note that Maryland did pass legislation that mandated insurance coverage for DBT after this survey had been completed. How could such a law impact these statistics?

“We anticipate an increase in our screening DBT rates once state mandate for DBT coverage goes in effect,” Chiu and colleagues wrote. “Over the past two years, more states have passed mandates to ensure coverage of DBT. Private insurers are also slowly accepting tomosynthesis with Cigna, Anthem, and United enacted policy to reimburse for DBT in all 50 states.”