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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 14 of 14 Research Studies Displayed
Cham S, Landrum MB, Keating NL
Use of germline BRCA testing in patients with ovarian cancer and commercial insurance.
The authors examined commercially insured populations to identify patient-, physician-, and practice-level characteristics associated with ovarian cancer testing rates. They found that only 33.9% of patients with commercial insurance were tested during the time period studied. Medical and gynecologic oncologists had similar rates of testing, while other physicians tested less often. Although independent practices often lack access to genetic counselors, women in this study had insurance coverage for in-person and telephonic counseling.
Citation: Cham S, Landrum MB, Keating NL . Use of germline BRCA testing in patients with ovarian cancer and commercial insurance. JAMA Netw Open 2022 Jan 4;5(1):e2142703. doi: 10.1001/jamanetworkopen.2021.42703..
Keywords: Cancer: Ovarian Cancer, Cancer, Screening, Genetics, Health Insurance, Women
Michel KF, Spaulding A, Jemal A
Associations of Medicaid expansion with insurance coverage, stage at diagnosis, and treatment among patients with genitourinary malignant neoplasms.
Health insurance coverage is associated with improved outcomes in patients with cancer. However, it is unknown whether Medicaid expansion through the Patient Protection and Affordable Care Act (ACA) was associated with improvements in the diagnosis and treatment of patients with genitourinary cancer. The objective of this study was to assess the association of Medicaid expansion with health insurance status, stage at diagnosis, and receipt of treatment among nonelderly patients with newly diagnosed kidney, bladder, or prostate cancer.
Citation: Michel KF, Spaulding A, Jemal A . Associations of Medicaid expansion with insurance coverage, stage at diagnosis, and treatment among patients with genitourinary malignant neoplasms. JAMA Netw Open 2021 May 3;4(5):e217051. doi: 10.1001/jamanetworkopen.2021.7051..
Keywords: Cancer, Medicaid, Health Insurance
Hatch B, Hoopes M, Darney BG
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Researchers assessed whether ACA implementation and Medicaid expansion were followed by greater receipt of recommended preventive services among women and girls in a large network of community health centers. Data was collected from electronic health records in 14 states. The researchers found that among female patients at community health centers, receipt of recommended preventive care improved after ACA implementation in both Medicaid expansion and non-expansion states, although the overall rates remained low. They recommended continued support to overcome barriers to preventive care in this population.
Citation: Hatch B, Hoopes M, Darney BG . Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states. Womens Health Issues 2021 Jan-Feb;31(1):9-16. doi: 10.1016/j.whi.2020.08.011..
Keywords: Cancer, Medicaid, Health Insurance, Uninsured, Access to Care, Policy, Cancer: Cervical Cancer, Prevention, Women, Healthcare Utilization
Maclean JC, Halpern MT, Hill SC
AHRQ Author: Hill SC
The effect of Medicaid expansion on prescriptions for breast cancer hormonal therapy medications.
The purpose of this study was to quantify the effects of the Affordable Care Act Medicaid expansion on prescriptions for effective breast cancer hormonal therapies (tamoxifen and aromatase inhibitors) among Medicaid enrollees. Data from the Medicaid State Drug Utilization Database was used. Findings showed that Medicaid expansion may have had a meaningful impact on the ability of lower-income women to access effective hormonal therapies used to treat breast cancer.
Citation: Maclean JC, Halpern MT, Hill SC . The effect of Medicaid expansion on prescriptions for breast cancer hormonal therapy medications. Health Serv Res 2020 Jun;55(3):399-410. doi: 10.1111/1475-6773.13289..
Keywords: Medicaid, Cancer: Breast Cancer, Cancer, Medication, Policy, Women, Healthcare Utilization, Access to Care, Health Insurance
Takvorian SU, Oganisian A, Mamtani R
Association of Medicaid expansion under the Affordable Care Act with insurance status, cancer stage, and timely treatment among patients with breast, colon, and lung cancer.
The effect of the Patient Protection and Affordable Care Act's Medicaid expansion on cancer care delivery and outcomes is unknown. Patients with cancer are a high-risk group for whom treatment delays are particularly detrimental. The objective of this study was to examine the association between Medicaid expansion and changes in insurance status, stage at diagnosis, and timely treatment among patients with incident breast, colon, and non-small cell lung cancer.
Citation: Takvorian SU, Oganisian A, Mamtani R . Association of Medicaid expansion under the Affordable Care Act with insurance status, cancer stage, and timely treatment among patients with breast, colon, and lung cancer. JAMA Netw Open 2020 Feb 5;3(2):e1921653. doi: 10.1001/jamanetworkopen.2019.21653.
Keywords: Cancer: Breast Cancer, Cancer: Colorectal Cancer, Cancer: Lung Cancer, Cancer, Health Insurance, Medicaid, Policy, Health Services Research (HSR)
Hassmiller Lich K, O'Leary MC, Nambiar S
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Researchers used microsimulation to estimate the health and financial effects of insurance expansion and reduction scenarios in North Carolina (NC) for colorectal cancer screening (CRC). The full lifetime of a simulated population of residents age-eligible for CRC screening (aged 50-75) during a 5-year period were simulated. Findings indicate that the estimated cost savings--balancing increased CRC screening/testing costs against decreased cancer treatment costs--were approximately $30 M and $970 M for Medicaid expansion and Medicare-for-all scenarios, respectively, compared to status quo. The researchers concluded that insurance expansion will likely improve CRC screening both overall and in underserved populations while saving money, with the largest savings realized by Medicare.
Citation: Hassmiller Lich K, O'Leary MC, Nambiar S . Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis. Prev Med 2019 Dec;129s:105847. doi: 10.1016/j.ypmed.2019.105847..
Keywords: Health Insurance, Cancer: Colorectal Cancer, Cancer, Healthcare Costs, Screening, Prevention, Medicaid, Medicare, Policy, Access to Care
Soni A, Sabik LM, Simon K
Changes in insurance coverage among cancer patients under the Affordable Care Act.
Uninsurance among patients with newly diagnosed cancer fell by one-third in the ACA’s first year. Coverage gains were significant across numerous common cancers, multiple demographic groups, and early-stage and late-stage disease. Large gains among Hispanic individuals were consistent with findings of other ACA studies and may indicate narrowing disparities.
Citation: Soni A, Sabik LM, Simon K . Changes in insurance coverage among cancer patients under the Affordable Care Act. JAMA Oncol 2018 Jan;4(1):122-24. doi: 10.1001/jamaoncol.2017.3176.
Keywords: Cancer, Health Insurance, Policy, Uninsured, Value
Smieliauskas F, Sharma H, Hurley C
State insurance mandates and off-label use of chemotherapy.
In this study, the investigators hypothesized that state health insurance mandates for private insurers to provide coverage for off-label use of cancer drugs cause higher rates of off-label use. They used Truven MarketScan data from 1999 to 2007 on utilization of 35 infused chemotherapy drugs in private health plans in the United States to study trends in off-label use of drugs, distinguishing between appropriate and inappropriate off-label use according to drug compendia, and estimated difference-in-difference regressions of the effect of state laws on off-label use.
Citation: Smieliauskas F, Sharma H, Hurley C . State insurance mandates and off-label use of chemotherapy. Health Econ 2018 Jan;27(1):e55-e70. doi: 10.1002/hec.3537.
Keywords: Access to Care, Cancer, Treatments, Health Insurance, Medication
Borah BJ, Yao X, Laughlin-Tommaso SK
Comparative effectiveness of uterine leiomyoma procedures using a large insurance claims database.
The objective of this retrospective analysis of administrative claims from a large U.S. commercial insurance database, was to compare risk of reintervention, long-term clinical outcomes, and health care utilization among women who have bulk symptoms from leiomyoma and who underwent the following procedures: hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided, focused ultrasound surgery.
Citation: Borah BJ, Yao X, Laughlin-Tommaso SK . Comparative effectiveness of uterine leiomyoma procedures using a large insurance claims database. Obstet Gynecol 2017 Nov;130(5):1047-56. doi: 10.1097/AOG.0000000000002331..
Keywords: Cancer, Comparative Effectiveness, Health Insurance, Outcomes, Patient-Centered Outcomes Research, Surgery, Women
Abdelsattar ZM, Hendren S, Wong SL
The impact of health insurance on cancer care in disadvantaged communities.
The extent to which health insurance can mitigate the effects of the social determinants of health on cancer care is unknown. This study of cancer patients diagnosed with the 4 leading causes of cancer deaths between 2007 and 2011 found that patients from disadvantaged communities benefit most from health insurance, and there is a reduction in disparities in outcome.
AHRQ-funded; HS020937; HS000053.
Citation: Abdelsattar ZM, Hendren S, Wong SL . The impact of health insurance on cancer care in disadvantaged communities. Cancer 2017 Apr 1;123(7):1219-27. doi: 10.1002/cncr.30431.
Keywords: Cancer, Health Insurance, Patient-Centered Outcomes Research, Vulnerable Populations
Shih YC, Smieliauskas F, Geynisman DM
Trends in the cost and use of targeted cancer therapies for the privately insured nonelderly: 2001 to 2011.
This study sought to define and identify drivers of trends in cost and use of targeted therapeutics among privately insured nonelderly patients with cancer receiving chemotherapy between 2001 and 2011. It found a large increase in the use of targeted intravenous anticancer medications and a gradual increase in targeted oral anticancer medications; targeted therapies accounted for 63 percent of all chemotherapy expenditures in 2011.
AHRQ-funded; HS018535; HS020263.
Citation: Shih YC, Smieliauskas F, Geynisman DM . Trends in the cost and use of targeted cancer therapies for the privately insured nonelderly: 2001 to 2011. J Clin Oncol 2015 Jul 1;33(19):2190-6. doi: 10.1200/jco.2014.58.2320..
Keywords: Value, Cancer, Health Insurance, Medication, Healthcare Costs
Geynisman DM, Hu JC, Liu L
Treatment patterns and costs for metastatic renal cell carcinoma patients with private insurance in the United States.
The researchers used a large claims database to examine the evolution of treatment patterns and associated costs for 1527 metastatic renal cell carcinoma (mRCC) patients in the United States. They found that the treatment of mRCC has transitioned from cytokines and cytotoxic chemotherapy to almost exclusively targeted therapy. Cost of care for mRCC is rising each year, and out-of-pocket costs for patients are significant.
AHRQ-funded; HS018535; HS020263.
Citation: Geynisman DM, Hu JC, Liu L . Treatment patterns and costs for metastatic renal cell carcinoma patients with private insurance in the United States. Clin Genitourin Cancer 2015 Apr;13(2):e93-100. doi: 10.1016/j.clgc.2014.08.013..
Keywords: Cancer, Kidney Disease and Health, Health Insurance, Healthcare Costs
Dual-eligibility status: a marker of vulnerability and cancer-related disparities.
This editorial discusses a study by Warren et al that highlights important differences in receipt of chemotherapy across subgroups of the Medicare population according to type of supplemental insurance. It explores the important questions raised by the findings, especially the individual factors that may have contributed to the observed disparities.
Citation: Koroukian SM . Dual-eligibility status: a marker of vulnerability and cancer-related disparities. J Clin Oncol 2015 Feb 1;33(4):297-8. doi: 10.1200/jco.2014.59.1933..
Keywords: Medicare, Cancer, Health Insurance, Treatments, Disparities
Erten MZ, Davidoff AJ, Zuckerman IH
AHRQ Author: Davidoff AJ
The effect of supplemental medical and prescription drug coverage on health care spending for Medicare beneficiaries with cancer.
The researchers examined whether patients with newly diagnosed cancer respond differently to supplemental coverage than the general Medicare population. They concluded that Medicare beneficiaries with cancer are less responsive to the presence and type of supplemental insurance than are beneficiaries without cancer. They recommended that policymakers consider welfare effects associated with coverage restrictions.
Citation: Erten MZ, Davidoff AJ, Zuckerman IH . The effect of supplemental medical and prescription drug coverage on health care spending for Medicare beneficiaries with cancer. Value Health 2014 Jan-Feb;17(1):15-21. doi: 10.1016/j.jval.2013.11.003.
Keywords: Cancer, Health Insurance, Medicare, Medication