Impact of Health Care Insurance Status on Treatment Outcomes of Acute Myeloid Leukemia

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Abstract

Micro-Abstract

Insurance status has been found to influence treatment outcomes in various solid tumors, but limited data is available for patients with acute myeloid leukemia (AML). A total of 161 patients were included in this retrospective study to examine the impact of insurance source in AML outcomes in the state of Oklahoma. Insurance source at diagnosis was found to have no impact on AML treatment outcomes and receipt of bone marrow transplant. The consistency of our results with some, but not all, studies is probably driven primarily by access-to-care requirements among different states.

Introduction:

Insurance status has been found to influence treatment outcomes in various solid tumors. Limited data with conflicting results are available in patients with acute myeloid leukemia (AML). We examined the impact of health insurance at diagnosis on AML treatment outcomes.

Patients and Methods:

All consecutive adult patients (≥ 18 years of age) diagnosed with AML between 2002 and 2011 and followed through August 2013 were included. Survival estimates were calculated by Kaplan-Meier survival curves. Logistic regression and multivariate Cox proportional hazards methods were used to explore the influence of multiple baseline covariates on treatment outcomes.

Results:

A total of 217 patients with complete medical records were identified. Of these, 161 patients had complete cytogenetic/molecular data for risk stratification and were included in the final efficacy analyses. Most patients (45.8%) were publicly insured, 36.3% were privately insured, and 17.3% were uninsured. No significant association was found between insurance source and cytogenetic/molecular risk status. Transplantation information was available for 157 patients, with no significant association found between transplant receipt and insurance source. After adjustment for age, cytogenetic/molecular risk, and transplant receipt, we found no statistically significant association between the insurance source and either event-free or overall survival.

Conclusion:

Insurance source at diagnosis has no impact on AML treatment outcomes. The consistency of our results with some, but not all, studies is probably driven primarily by access-to-care eligibility requirements among different states. Further efforts to better understand such disparities are warranted.

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