Presentation Authors: Adam Weiner*, Adarsh Manjunath, Chicago, IL, Gary Kirsh, Cincinnati, OH, Jeffrey Scott, West Palm Beach, FL, Raoul Concepcion, Nashville, TN, John Verniero, West Palm Beach, FL, Deepak Kapoor, New York, NY, Neal Shore, Myrtle Beach, SC, Edward Schaeffer, Chicago, IL
Introduction: The true costs of a contemporary prostate biopsy and the incremental impact of complications on cost are unknown. We performed a retrospective analysis of all Medicare fee-for-service claims for prostate biopsies in the United States over two years to quantify the costs of prostate biopsies and their complications.
Methods: From January 31, 2014 to December 1, 2015, costs for each prostate biopsy episode among Medicare patients (including 30 days following each biopsy) were calculated. The effects of infectious and bleeding complications, biopsy setting, and subsequent inpatient hospitalization were explored.
Results: The average cost of the 234,819 biopsies reviewed was $2020, and $920 (46%) of biopsy cost occurred in the 30 days following each biopsy. Biopsies performed in the office setting comprised 66% of total biopsies and were least costly â€“ with an average cost of $1750. Biopsies performed in ambulatory surgical centers ($2260) and outpatient hospital settings ($2730) were more costly than office biopsy (both p < 0.001) with most of the additional costs rendered on the day of the biopsy. Biopsies performed within the office setting were associated with fewer complications (10%) compared to the outpatient hospital (19%) or ambulatory surgical center settings (12%; both p < 0.001). An uncomplicated biopsy episode averaged across all biopsy settings cost an average of $1740. This cost increased to $4060 when at least one complication occurred (Difference +$2320; p < 0.001) and most of these added costs were seen in the 30 days following a biopsy. The largest charges incurred were related to inpatient hospitalizations ($15470 versus $1630 when there was no hospitalization, p < 0.001) but was rare constituting only 2.8% of biopsies.
Conclusions: Nearly half of costs during prostate biopsy episodes occur in the days following a biopsy and are largely related to biopsy complications. These data should be used as benchmarks to incentivize interventions to reduce complications and subsequent admissions following biopsies.