Out-of-pocket costs incurred by patients receiving imaging studies nearly doubled between 2000 and 2019, according to research published online October 6 in the Journal of the American College of Radiology.
A team of researchers led by Eshani Choksi, a medical student at Rowan University in Glassboro, NJ, analyzed national surveys containing out-of-pocket imaging costs from over 100,000 patients between 2000 and 2019. They found that out-of-pocket costs for noninvasive imaging studies increased by a mean of 89.8% over the study period.
"As diagnostic imaging utilization increases, patient financial hardship considerations merit further attention," wrote Choksi, corresponding author Kumar Mukherjee, PhD, of Philadelphia College of Osteopathic Medicine, and colleagues.
The group studied annual cost data for 229,010 noninvasive imaging exams (mammography, radiography, ultrasound, and CT or MRI) from 102,717 patients included in the Agency for Healthcare Research and Quality (AHRQ) Medical Expenditure Panel Survey (MEPS) from 2000 to 2019. The MEPS is a patient-centered U.S. household survey.
After calculating the total cost of all imaging studies performed during all encounters, the researchers then estimated mean overall expenditures and mean out-of-pocket costs for each year by summing the respected costs incurred by all respondents reporting imaging in that calendar year and then dividing by the number of respondents.
Furthermore, they estimated the mean overall expenditures and mean out-of-pocket costs for each of the four modalities by assessing encounters with a single imaging exam. They then indexed all costs to 2020 dollars after adjusting for inflation.
Overall, the mean patient out-of-pocket costs for imaging studies increased from $97.97 in 2000 to $185.91 in 2019, up 89.8%.
| Increase in patient out-of-pocket costs for imaging studies from 2000 to 2019 | ||
| Increase in mean costs | Increase in patient out-of-pocket costs from 2000 to 2019 | |
| Ultrasound | 40% ($771.61 to $1,079.8) | 123.2% ($96.87 to $216.17) |
| Radiography | 24.5% ($842.88 to $1,049.09) | 81% ($84.34 to $152.68) |
| CT/MR | -15.1% ($1,692.69 to $1,436.92) | 61% ($104.89 to $168.89) |
| Mammography | 14.5% ($387.55 to $443.54) | -32.9% ($37.23 to $25) |
Delving further into the data, the study authors found that patient comorbidities, lack of insurance, a younger age, and history of cancer were variables that significantly increased out-of-pocket costs.
The researchers noted that high out-of-pocket costs could impact financially challenged patients, limiting their access to imaging services.
"Optimal cost-containment strategies should be in place to alleviate financial hardship, without compromising patients' health outcomes," they wrote.
Furthermore, indirect costs such as transportation fees can also act as an additional potential barrier for patients, according to the group. The team pointed out that interventions such as providing rideshare services have been shown to reduce financial burdens and improve access to imaging services.
"Finally, advancing price transparency initiatives such as online price estimator tools, training imaging center facing personnel (specifically, schedulers) on addressing patients' concerns about their expected [out-of-pocket] costs, insurance coverage, and referral to financial navigation programs could help mitigate financial hardship," Choksi et al wrote.
