Gross Cary P, Meyer Craig S, Ogale Sarika, Kent Matthew, Wong William B
Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale Cancer Center, and.
Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
J Natl Compr Canc Netw. 2022 May;20(5):479-487.e2. doi: 10.6004/jnccn.2021.7083.
Evidence suggests that patients with Medicaid experience lower-quality cancer care than those with commercial insurance. Whether this trend persists in the era of personalized medicine is unclear. This study examined the associations between Medicaid (vs commercial) insurance and receipt of biomarker testing, targeted therapy, and overall survival in patients with advanced non-small cell lung cancer (aNSCLC).
We conducted a retrospective study of patients who received an aNSCLC diagnosis from January 2011 to September 2019 using a nationwide US healthcare database. Eligible patients were aged 18 to 64 years with Medicaid or commercial insurance at diagnosis. Receipt of biomarker testing (ALK, EGFR, ROS1, BRAF, and PD-L1) was assessed. The likelihood of testing, biomarker-driven therapy (cancer immunotherapy or tyrosine kinase inhibitor treatment), and mortality were compared by insurance type using adjusted Cox regression.
Our sample included 6,145 commercially insured and 865 Medicaid beneficiaries. Medicaid beneficiaries were more likely to be Black or African American (20% vs 9.3%; P <.001) and were less likely to have undergone biomarker testing (57% vs 71%; P <.001). In the adjusted analysis, Medicaid beneficiaries were less likely to have evidence of testing (hazard ratio [HR], 0.81; P <.001), any first-line treatment (HR, 0.72; P <.001), and first-line biomarker-driven therapy (HR, 0.70; P <.001). Medicaid beneficiaries with evidence of biomarker testing had a lower risk of death compared with those without evidence of biomarker testing (HR, 1.27 [95% CI, 1.06-1.52]; P =.010). Higher risk of death was observed in patients with Medicaid versus commercially insured patients (HR, 1.23; P <.001); this result remained unchanged after adjusting for biomarker testing (HR, 1.22; P < .001) but was partially ameliorated after adjustment for testing and treatment type (HR, 1.12; P =.010).
Medicaid beneficiaries with aNSCLC were less likely to receive biomarker testing and biomarker-driven therapies, which may in part contribute to a higher observed risk of mortality compared with commercially insured patients.
有证据表明，与商业保险患者相比，医疗补助计划（Medicaid）的患者接受的癌症治疗质量较低。在个性化医疗时代，这种趋势是否持续尚不清楚。本研究调查了医疗补助计划（与商业保险相比）与晚期非小细胞肺癌（aNSCLC）患者接受生物标志物检测、靶向治疗及总生存期之间的关联。
我们使用美国全国性医疗保健数据库，对2011年1月至2019年9月期间被诊断为aNSCLC的患者进行了一项回顾性研究。符合条件的患者年龄在18至64岁之间，诊断时拥有医疗补助计划或商业保险。评估生物标志物检测（ALK、EGFR、ROS1、BRAF和PD-L1）的接受情况。使用校正后的Cox回归按保险类型比较检测可能性、生物标志物驱动治疗（癌症免疫治疗或酪氨酸激酶抑制剂治疗）及死亡率。
我们的样本包括6145名商业保险受益人和865名医疗补助计划受益人。医疗补助计划受益人更有可能是黑人或非裔美国人（20%对9.3%；P<.001），且接受生物标志物检测的可能性较小（57%对71%；P<.001）。在校正分析中，医疗补助计划受益人进行检测的可能性较小（风险比[HR]，0.81；P<.001），接受任何一线治疗的可能性较小（HR，0.72；P<.001），接受一线生物标志物驱动治疗的可能性较小（HR，0.70；P<.001）。有生物标志物检测证据的医疗补助计划受益人比没有生物标志物检测证据的受益人死亡风险更低（HR，1.27[置信区间95%，1.06 - 1.52]；P =.010）。与商业保险患者相比，医疗补助计划患者的死亡风险更高（HR，1.23；P<.001）；在对生物标志物检测进行校正后，这一结果保持不变（HR，1.22；P<.001），但在对检测和治疗类型进行校正后有所改善（HR，1.12；P =.
