Association of Receipt of Systemic Treatment for Melanoma With Insurance Type in North Carolina.

Autor:	Adamson AS; Department of Internal Medicine, Dell Medical School.; LIVESTRONG Cancer Institutes, The University of Texas at Austin, Austin, TX.; Department of Dermatology., Jackson BE; Lineberger Comprehensive Cancer Center., Baggett CD; Lineberger Comprehensive Cancer Center.; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC., Thomas NE; Department of Dermatology.; Lineberger Comprehensive Cancer Center., Haynes AB; LIVESTRONG Cancer Institutes, The University of Texas at Austin, Austin, TX.; Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX., Pignone MP; Department of Internal Medicine, Dell Medical School.; LIVESTRONG Cancer Institutes, The University of Texas at Austin, Austin, TX.
Jazyk:	angličtina
Zdroj:	Medical care [Med Care] 2023 Dec 01; Vol. 61 (12), pp. 829-835. Date of Electronic Publication: 2023 Sep 13.
DOI:	10.1097/MLR.0000000000001921
Abstrakt:	Background: Previous studies of hospital-based patients with metastatic melanoma suggest sociodemographic factors, including insurance type, may be associated with the receipt of systemic treatments. Objectives: To examine whether insurance type is associated with the receipt of systemic treatment among patients with melanoma in a broad cohort of patients in North Carolina. Methods: We conducted a retrospective cohort study between 2011 and 2017 of patients with stages III-IV melanoma using data from the North Carolina Central Cancer Registry linked to Medicare, Medicaid, and private health insurance claims across the state. The primary outcome was the receipt of any systemic treatment, and the secondary outcome was the receipt of immunotherapy. Results: A total of 372 patients met the inclusion criteria. The average age was 68 years old (interquartile range: 56-76) and 61% were male. Within the cohort 48% had Medicare only, 29% had private insurance, 12% had both Medicare and Medicaid, and 11% had Medicaid only. A total of 186 (50%) patients received systemic treatment for melanoma, 125 (67%) of whom received immunotherapy. The use of systemic therapy, including immunotherapy, increased significantly over time. Having Medicaid-only insurance was independently associated with a 45% lower likelihood of receiving any systemic treatment [0.55 (95% CI: 0.35, 0.85)] and a 43% lower likelihood of receipt of immunotherapy [0.57 (95% CI: 0.34, 0.95)] compared with private insurance. Conclusions: Stage III-IV melanoma patients with Medicaid-only insurance were less likely to receive systemic therapy or immunotherapy than patients with private insurance or Medicare insurance. This finding raises concerns about insurance-based disparities in treatment access. Competing Interests: A.S.A. is supported by the Dermatology Foundation Public Health Career Development Award, by the National Institutes of Health under grant NIH UL1 TR002645, and by the American Cancer Society. The remaining authors declare no conflict of interest. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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