Impact of the Affordable Care Act and Medicaid Expansion Among Patients With HIV-Associated Aggressive B-Cell Non-Hodgkin Lymphomas.

Autor:	Premnath N; Division of Hematology, Oncology and Transplantation, University of Minnesota, Masonic Cancer Center, Minneapolis, MN., Liu Y; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX., Reves H; Section of Hematologic Malignancies and Cellular Therapy, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX., Pandey U; Section of Hematologic Malignancies and Cellular Therapy, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX., Nair RG; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX., Anderson J; Section of Hematologic Malignancies and Cellular Therapy, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX., Afrough A; Section of Hematologic Malignancies and Cellular Therapy, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX., Anderson LD Jr; Section of Hematologic Malignancies and Cellular Therapy, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX., Chung SS; Section of Hematologic Malignancies and Cellular Therapy, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX., Kaur G; Section of Hematologic Malignancies and Cellular Therapy, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX., Khan AM; Section of Hematologic Malignancies and Cellular Therapy, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX., Kumar KA; Department of Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX., Madanat YF; Section of Hematologic Malignancies and Cellular Therapy, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX., Wolfe HR; Section of Hematologic Malignancies and Cellular Therapy, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX., Yilmaz E; Section of Hematologic Malignancies and Cellular Therapy, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX., Awan FT; Section of Hematologic Malignancies and Cellular Therapy, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX., Sweetenham J; Section of Hematologic Malignancies and Cellular Therapy, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX., Ramakrishnan Geethakumari P; Section of Hematologic Malignancies and Cellular Therapy, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX.
Jazyk:	angličtina
Zdroj:	JCO oncology practice [JCO Oncol Pract] 2024 Oct 17, pp. OP2400354. Date of Electronic Publication: 2024 Oct 17.
DOI:	10.1200/OP.24.00354
Abstrakt:	Purpose: To study the influence of the Affordable Care Act (ACA) policy and its Medicaid expansion on insurance status and survival in patients with HIV with aggressive lymphoma. Methods: We used the National Cancer Database, a hospital-based national registry, to identify adults age 18-64 years with HIV-associated aggressive B-cell non-Hodgkin lymphomas (HIV-a-B-NHLs), diagnosed during 2007 to 2016. Survival analysis was performed on a subset of patients with HIV-a-B-NHL for whom location data were available who resided in Medicaid expansion-adopted and nonadopted states. Using a quasi-experimental difference-in-difference model, the difference in adjusted 2-year survival rates obtained with a flexible parametric Weibull model was compared for states that adopted the Medicaid expansion of ACA against those that did not adopt the expansion. Results: We identified 8,231 patients with HIV-a-B-NHL and 50,650 non-HIV patients with a-B-NHL. We found that a lower proportion of individuals were uninsured at diagnosis in the expansion states compared with nonexpansion states. We also found that the ACA policy adoption led to a reduction in the proportion of uninsured individuals with HIV-a-B-NHL in expansion states of 34.9%, compared with 15.9% in non-expansion-adopted states. There was a statistically significant improvement in the 2-year survival rate among patients with HIV-a-B-NHL in the expansion compared with nonexpansion states with the adoption of ACA (7.17% v 1.58%, P = .02). Conclusion: Using a novel quasi-experimental model, we found that the ACA policy corresponded with a greater survival improvement in patients with HIV-a-B-NHL within Medicaid expansion-adopted states compared with nonexpansion states. We believe that this evidence should be taken into consideration in future policy making.
Databáze:	MEDLINE
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