Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2019 ASCO Annual Meeting but not presented at the Meeting, can be found online only.
Biomarker testing, treatment (Tx) and survival outcomes in Medicaid compared to commercially insured (CI) patients with advanced NSCLC (aNSCLC).
Disparities/Access to Care
Health Services Research, Clinical Informatics, and Quality of Care
2019 ASCO Annual Meeting
J Clin Oncol 37, 2019 (suppl; abstr e18119)
Author(s): Yeun Mi Yim, Ning Wu, William Bruce Wong; Genentech, South San Francisco, CA; Genentech, Inc., South San Francisco, CA
Background: Prior studies suggest cancer patients with Medicaid may have worse outcomes, however there is limited understanding on the drivers behind these observations. This study aimed to describe the association between insurance type with Tx patterns, biomarker testing, and survival outcomes in a real-world aNSCLC population. Methods: The Flatiron Health EHR-derived database was used to identify patients < 65 years of age diagnosed with aNSCLC between 1/1/2011 to 10/31/2018. Logistic regression was used to assess the association between insurance type and (1) the likelihood of receiving first-line Tx of cancer immunotherapy (CIT)/other targeted therapy, or no Tx, and (2) the likelihood of receiving EGFR/ALK testing. Median OS, estimated by Kaplan Meier, was compared between patients with CI and Medicaid coverage, and hazard ratios were derived from Cox proportional hazard models adjusting for baseline characteristics. Results: 6639 aNSCLC patients were identified with CI (n = 6022) and Medicaid (n = 617). After adjusting for baseline characteristics, Medicaid patients were less likely to receive ALK or EGFR testing [OR 0.59, 95% CI (0.49, 0.72)]. Medicaid patients were also less likely to receive CIT or targeted therapy [OR 0.49, 95% CI (0.36,0.67)] and more likely to not receive any systemic Tx [OR 1.45, 95% CI (1.22, 1.73)]. Medicaid patients had a higher risk of death than commercially insured patients, however this difference varied by Tx group (table). Conclusions: Medicaid insured patients were associated with a higher risk of mortality compared to CI patients. Factors influencing this difference may be access to biomarker testing, subsequent receipt of CIT/targeted therapy and differences in care among untreated patients.
|Tx Group||Insurance Type (n)||Median OS (mo.)||Adjusted HR (95% CI), p value|
|All Patients||CI (n = 6022)||11.9||ref.|
|Medicaid (n = 617)||9.8||1.14 (1.02, 1.26), p = 0.02|
|CIT/Targeted||CI (n = 1088)||19.1||ref.|
|Medicaid (n = 54)||10.9||1.30 (0.88, 1.92), p = 0.20|
|Chemo/Biologic||CI (n = 3073)||10.2||ref.|
|Medicaid (n = 304)||9.8||1.02 (0.88, 1.18), p = 0.78|
|Untreated||CI (n = 1861)||9.7||ref.|
|Medicaid (n = 259)||8.2||1.24 (1.06, 1.46), p = 0.01|