Increasing Utilization of Sedation for Prostate Biopsies: National Trends, Predictors, and Patient Cost.

Objective: To describe national trends, predictors, insurance, and patient costs associated with sedation use during prostate biopsies.

Methods: We conducted a retrospective cohort study using the Merative Marketscan Database from 2016 to 2021. Men undergoing prostate biopsy were identified using CPT codes. Biopsy type, anesthesia claims, comorbidities, and magnetic resonance imaging (MRI) use were determined through current procedural terminology/International Classification of Diseases 10th revision codes. Multivariable logistic regression assessed predictors of sedation use. Out-of-pocket costs were calculated by summing insurance copays, deductibles, and coinsurance, adjusted to 2021 dollars.

Results: The final cohort included 172,148 prostate biopsies. The mean patient age was 62 ± 8 years. The proportion of biopsies performed with sedation increased from 15.6% in 2016 to 25.5% in 2021. Saturation biopsies were 9 times more likely to involve sedation than systematic biopsies (OR = 9.02, 98% CI = 8.18-9.95, P <.001). Patients with a prior biopsy were 39% more likely to receive sedation (OR = 1.39, 98% CI = 1.35-1.43, P <.001). MRI-guided biopsies were nearly twice as likely to involve sedation compared to non-MRI biopsies (OR = 1.98, 98% CI = 1.93-2.04, P <.001). In 2021, the expected out-of-pocket cost for sedated biopsies was $663 USD (98% CI = $644-$682), compared to $489 USD (98% CI = $479-$498) for non-sedated procedures.

Conclusion: Sedation use during prostate biopsies is steadily increasing, alongside associated patient costs. Patients undergoing saturation biopsies and MRI-guided procedures, and those with prior biopsy history, were more likely to receive sedation. These findings highlight evolving patterns in biopsy practices and underscore the need to balance patient comfort with procedural cost and accessibility considerations.