LAUSR

Introduction: The proliferation of health savings accounts has empowered patients to participate in medical decisions through a direct financial incentive. Using conjoint analysis we examined how much extra patients with a health savings account would be willing to pay for magnetic resonance imaging‐transrectal ultrasound fusion guided prostate biopsy over transrectal ultrasound guided prostate biopsy. Methods: We enrolled men who were 55 to 70 years old from a general urology clinic. We performed a literature review, distributed surveys and conducted semi‐structured interviews to develop and rank attributes commonly used to compare magnetic resonance‐ultrasound to transrectal ultrasound guided prostate biopsy. Using conjoint surveys we asked participants to select their preferred choice between 2 hypothetical biopsy interventions with differing levels of the attributes and cost. Results of the conjoint surveys were analyzed using a multinomial probit model. We performed a sensitivity analysis to assess the stability of our results after adjusting for age, history of prostate cancer, race, education, marital status, income and Zip Code of residence. Results: Patients were willing to pay $1,598 more for a biopsy intervention with increased sensitivity to detect all cancer from 43% to 51% and $2,034 more for a negative predictive value improvement from 70% to 90%. Patients were not willing to pay extra for an intervention with improved sensitivity to detect high risk cancer alone. These estimates did not change with our sensitivity analysis. Conclusions: Our findings suggest that patients are willing to pay approximately $1,500 to $2,000 from a health savings account for a biopsy intervention with a benefit profile similar to that of magnetic resonance‐ultrasound guided prostate biopsy.