Link Between Medicaid and Rates of Biomarker Testing in NSCLC

Cary Gross, MD, professor of medicine and of epidemiology, and founder and director, the Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine; director, Adult Primary Care Center, Quality Improvement; chair, National Clinician Scholars Program; and director, National Clinician Scholars Program, discusses the findings from a retrospective study which revealed there to be an association between Medicaid insurance, rates of biomarker testing, and patient outcomes among patients with advanced non–small cell lung cancer (NSCLC).

The study was published in the Journal of the National Comprehensive Cancer Network and assessed 6,145 commercially insured patients and 865 Medicaid beneficiaries with advanced NSCLC. Data was collected from electronic medical records of patients with advanced NSCLC who were between the ages of 18 and 64. The recommended biomarker tests for advanced NSCLC include ALK, EGFR, ROS, and BRAF gene alterations, as well as PD-L1 expression, and the recommended biomarker-driven therapies for advanced NSCLC were immunotherapy or tyrosine kinase inhibitor treatment.

Findings revealed that Medicaid beneficiaries were less likely to have gotten biomarker testing (HR, 0.81; P < .001), any first-line treatment (HR, 0.72; P < .001), or first-line biomarker-driven therapy (HR, 0.70; P < .001) compared with commercially insured patients. Those weho were Medicaid beneficiaries also were more likely to be Black or African American (20% and 9.3%) (P < .001), respectively. This also showed that they were less likely to undergo biomarker testing at 57% vs 71% (P < .001).

Transcription:

0:08 | The natural question was, if the Medicaid patients are less likely to get biomarker testing, are they also less likely to get biomarker-driven therapy? And, as one would expect, that's exactly what we found. Medicaid beneficiaries were 30% less likely to receive biomarker-driven therapy, then commercially insured patients. Unfortunately, we also found that patients with Medicaid had a 23% higher risk of death than patients with private insurance. Then, what we did is we then adjusted in our model for whether each individual patient had received biomarker testing and biomarker treatment.

0:54 | We looked at the difference in mortality without adjusting for who got [testing]. And as I mentioned, the Medicaid patients were 23% more likely to die, then we accounted for who got testing and treatment. And we found that the relative risk decreased somewhat so the higher risk was down to 15% associated with Medicaid. What that means is [with] unadjusted Medicaid, 23% had higher risk of death. After we accounted for biomarker testing and treatment, Medicaid patients [had a] 15% higher risk of death. That means that a fair proportion of this disparity in survival in Medicaid patients can be attributed to this lack of access to testing and treatment. These findings strongly suggest that treatment is 1 of the main culprits in why Medicaid patients with lung cancer are having worse outcomes.