Insurance Status Impacts Overall Survival in Younger Patients With CML
Patients with chronic myelogenous leukemia age 64 or younger had significantly worse overall survival rates.
Patients with chronic myelogenous leukemia (CML) age 64 or younger had significantly worse overall survival rates compared with patients with insurance.1
Although survival among patients with CML has improved with the use of tyrosine kinase inhibitors, several factors such as access to care, medication cost, and adherence can interfere with therapeutic effectiveness. Researchers sought to determine if insurance status at time of diagnosis influenced patient outcomes.
Investigators identified 5784 patients with CML diagnosed between 2007 and 2012 using the Surveillance, Epidemiology, and End Results Program (SEER) database. Patients were age 15 and older, and were categorized as having private insurance, Medicaid coverage, or uninsured. The study's primary outcome was overall survival according to insurance status.
Results showed that at diagnosis, uninsured or Medicaid patients between the ages of 15 and 64 tended to be younger, not married, non-white race, and Hispanic ethnicity.
At a median follow-up of 32 months, patients who were uninsured or had Medicaid had worse survival compared to insured patients, with a 5-year overall survival rate of 72.2% for uninsured patients, 73.1% for Medicaid patients, and 86.6% for the privately insured (P < .0001). Patients who were age 65 or older had no significant difference in 5-year overall survival between patients with Medicaid and those with other insurance (40.2% vs 43.4%; P = .0802).
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Multivariate analysis of patients younger than 65 revealed increased mortality among patients who were uninsured (HR, 2.156; P < .0001) or had Medicaid (HR, 1.972; P < .0001). Worse survival was correlated with increased age (HR, 1.046 per year; P < .0001), male sex (HR, 1.282; P = .0279), and being single (HR, 1.883; P < .0001).
“Despite highly effective therapies currently available for CML, these findings suggest that many patients may not have access to or receive appropriate care, in part related to insurance coverage,” the study authors concluded.
- Perry AM, Zou T, Brunner AM, et al. The impact of insurance status at diagnosis on overall survival in chronic myeloid leukemia: a population-based analysis [abstract]. Blood. 2015;126(23):631.