A wider range of providers are investing in sophisticated biopsy equipment for prostate cancer, even though there's limited reimbursement for the technology and disagreement as to whether the disease needs to be intensively treated.
MRI/Ultrasound fusion prostate biopsy systems have historically been found more often in teaching hospitals than other institutions, but data shows that non-research institutions may be investing in the product as it has gained acceptance as a potential standard-of-care in the future. Even physician groups seem to be acquiring the product in an effort to attract patients.
The equipment allows providers to pair an MRI image of the prostate with ultrasound imaging used during a biopsy of the organ, offering a 3D model of the prostate that can make it easier to target lesions. The addition of a pelvic MRI to the prostate screening process could mean an additional $1,000 to $2,000 cost for a patient, but doctors point out that a biopsy won't be necessary if there's no indication of cancer on the MRI.
Data from the ECRI Institute shows that, although teaching hospitals accounted for 75% of interest in the equipment in 2013, those facilities only account for 20% so far in 2016. ECRI's data doesn't discern between hospitals and medical practices, but experts tell Modern Healthcare that there is growing interest in the equipment among large urology practices.
Greater Boston Urology, a 17-doctor medical group, has been using MRI/Ultrasound fusion technology for the past four years, initially using the Artemis system produced by Grass Valley, Calif-based Eigen and upgrading last year to the UroNav system produced by Invivo, a subsidiary of Dutch conglomerate Royal Philips. Chief Operating Officer Les Cavicchi said large urology practices are increasingly investing in the equipment in an effort to compete with hospitals, because the procedure doesn't necessarily have to be performed in a hospital.
“This is very expensive technology, but the investment is worth it because the physician maintains control over the relationship with the patient, including the long-term treatment plan,” Cavicchi said.
The equipment can cost between $70,000 and $250,000, and costs $165,000 on average, according to ECRI data reported this year. Because the technology is relatively new and there's limited data to show any advantage over traditional biopsy, the procedure is still considered by many payers to be investigational, which means providers can't get additional reimbursement beyond a standard biopsy rate.
That hasn't discouraged urology practices from purchasing the equipment, because they say an increase in patient volume from individuals interested in the technology should help defray the premium costs. Cavicchi said patients are searching for 3D biopsy services on the web and physicians throughout New England have referred patients to their practice for the procedure.
MRI/Ultrasound fusion for prostate biopsy is yet another example of equipment that is being acquired by providers despite a lack of extensive data on its improvements over existing products. A number of providers have purchased devices like proton therapy equipment, dissolvable artery stents and da Vinci surgical robots, and heavily invested in marketing these services, even though data doesn't yet show they're any better than conventional procedures.
Not all patients need to undergo the MRI-guided procedure, but it can be useful for patients who've previously had a negative biopsy or has already been diagnosed and are receiving regular biopsies, said Dr. Judd Boczko, a urologist at Purchase, N.Y.-based WestMed Medical Group. As therapy options become more advanced in the future, it may help localize treatment if cancerous cells are shown to be isolated to specific areas.
WestMed, a 300-doctor multispecialty group, is the first medical practice in the U.S. to offer the procedure using Navigo, a fusion device manufactured by Israel-based UC-Care Medical Systems. Navigo is the group's first fusion system. Avi Kamelhar, COO of Axella BioVentures, the exclusive U.S. distributor of Navigo, said large urology practices are recognizing that the fusion procedure will likely become the standard-of-care, instead of a basic ultrasound biopsy.
“Over time they're going to want it for competition, and I think they're definitely looking at it now,” Kamelhar said, noting that a large medical group that includes a radiology practice may be able to increase MRI revenue if they buy the equipment. He claimed that Navigo is particularly suited for physician practices because it allows them to use their existing ultrasound equipment and has a lower price point than competitors, but he declined to share that price.
Prostate cancer screening and treatment is a controversial topic because research has shown that prostate cancer-related mortality rates are low regardless of whether an individual with prostate cancer is actively monitored or receives radiation therapy. The U.S. Preventive Services Task Force decided in 2012 to recommend against the blood test used to screen patients for prostate cancer, because it may result in treatment of tumors that otherwise wouldn't have harmed the patient.
Only 17 prostate cancer-related deaths were reported in a recent 10-year study of over 1,600 patients in the U.K., although higher disease progression and spreading of the cancer was reported in patients who underwent active monitoring. The mortality rate for any cause, including prostate cancer, was still low at 10%.
Nonetheless, there is concern among urologists that, without screening, physicians may miss more serious cancers. A recent Northwestern University Study reported that new cases of metastatic prostate cancer – the term for when the disease has spread to other parts of the body – were up 72% between 2004 and 2013, which the authors said could be due to the change in screening policy, or the disease may have just become more aggressive over time. Some researchers cast doubt on whether the Northwestern analysis was too limited to come to the conclusion that lax screening was to blame.