(S015) Impact of Health Insurance Status on Prostate Cancer Treatment Modality Selection in the United States

April 30, 2015

Patients without insurance were less than half as likely to receive MIS and more than twice as likely to receive EBRT compared with patients with private insurance in our national cohort. Our findings suggest that with expanding access to private insurance under the Affordable Care Act, there may be significant shifts in the selection of treatment modality for men with prostate cancer in the United States.

Trevor Bledsoe, MD, Henry Park, MD, MPH, Charles Rutter, MD, Sanjay Aneja, MD, James Yu, MD, MHS; Department of Therapeutic Radiology, Yale University School of Medicine

INTRODUCTION: A variety of treatment modalities are available for the management of men with clinically localized prostate cancer in the United States. In addition to clinical factors, treatment choice may be influenced by a patient’s insurance status. We investigated the influence of health insurance on prostate cancer treatment modality selection in the United States.

METHODS: Men aged 18–65 years treated for localized prostate cancer from 2010–2011 were identified in the National Cancer Data Base. Patients with no insurance or private insurance were included. Treatment modalities included minimally invasive surgery alone (MIS), open surgery alone, external beam radiotherapy alone (EBRT), proton therapy alone, brachytherapy alone, hormone therapy alone, active surveillance, and combinations of treatments. Demographic and clinical covariates included age, race, income, education level, year of diagnosis, treatment facility type, D’Amico risk classification, and Charlson/Deyo score. Chi-square and multivariable logistic regression analyses were used to evaluate the association of insurance status and other covariates with treatment modality selection.

RESULTS: We identified 67,370 patients with either no insurance (3.2%) or private insurance (96.8%). The greatest disparities in treatment modality by insurance status were observed among men receiving MIS and EBRT. For patients with no insurance, 35.1% received MIS and 25.6% received EBRT. For patients with private insurance, 60.1% received MIS and 9.7% received EBRT. Insurance status was the strongest predictor of receipt of both MIS and EBRT on multivariable analysis. Lack of insurance was associated with decreased utilization of MIS (odds ratio [OR] = 0.39; 95% confidence interval [CI], 0.36–0.43; P < .001) and increased utilization of EBRT (OR = 2.56; 95% CI, 2.27–2.85; P < .001). 

CONCLUSIONS: Patients without insurance were less than half as likely to receive MIS and more than twice as likely to receive EBRT compared with patients with private insurance in our national cohort. Our findings suggest that with expanding access to private insurance under the Affordable Care Act, there may be significant shifts in the selection of treatment modality for men with prostate cancer in the United States.

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org