Biomarker Testing in Lung Cancer Dependent on Type of Health Insurance

Cary Gross, MD, discusses the results of a retrospective study of patients with advanced non-small cell lung cancer (NSCLC) that showed an association between Medicaid insurance, rates of biomarker testing, and patient outcomes.

The study, published in the Journal of the National Comprehensive Cancer Network, looked at a sample of 6,145 commercially insured and 865 Medicaid beneficiaries with advanced NSCLC. These patients received their diagnosis between January 2011 to September 2019 and data was collected from a nationwide US healthcare database.

What researchers found was 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). Moreover, the Medicaid beneficiaries were more likely to be Black or African America at 20% and 9.3% (P < .001), respectively, which also showed they were less likely to undergo biomarker testing at 57% vs 71% (P < .001).

These differences impacted patient outcomes as the Medicaid beneficiaries who had biomarker testing had a lower risk of death compared with patients without biomarker testing (HR, 1.27; 95% CI, 1.06–1.52; P = .010). However, when compared to commercially insured patients with NSCLC there was a higher risk of death for Medicaid beneficiaries (HR, 1.23; P < .001) that was only slightly adjusted when considering testing and treatment type for patients (HR, 1.12;P = .010).

Gross, founder, and director of Yale's Cancer Outcomes Public Policy & Effectiveness Research Center, notes that these testing disparities were observed when looking at the individual biomarker tests as well. For instance, 51% of Medicaid beneficiaries had EGFR testing vs 65% in the commercially insured group and 48% of Medicaid beneficiaries had evidence of ALK testing vs 63%. However, rates of biomarker testing were still low in both groups for PD-L1 testing at 37% in the commercially insured group vs 28% in the Medicaid group and 34% vs 22%, respectively, in BRAF testing,

Gross discusses these differences between the commercially insured beneficiaries and the patients on Medicaid but also highlights how patients in general may not be getting the levels of biomarker testing they need.

Transcription:

0:07 | With regard to testing, we found that patients with Medicaid were substantially less likely to get biomarker testing. So, for instance, in EGFR testing about 65% of privately insured patients received EGFR testing vs 41% of Medicaid patients. ALK testing was at 63% of private vs 48% of Medicaid, and this was a consistent finding across all the different biomarkers that we looked at. Finally, if you put it all together to ask the question, which patients received all the tests they're supposed to be getting at any given time, rather than each of the individual biomarkers, we found that 45% of patients with private insurance had received all the recommended testing. But only 34% of patients who have Medicaid [received all the recommended testing].

1:04 | So, there's 2 main findings here. First of all, there is a difference, Medicaid is substantially less than private insurance, but also, even on private insurance only 45% of patients were getting the recommended testing [at data cutoff]. I think here we're in a situation where it's important to look at the inequity, but also, it's important to look at the overall focus of about what we're doing and how we can intervene to improve access to biomarker testing for all patients.