Impact of Medicaid Expansion on the Treatment and Outcomes of Intrahepatic Cholangiocarcinoma
Introduction The Affordable Care Act increased insurance coverage for patients residing in states that expanded Medicaid coverage, but its impact on the outcomes of intrahepatic cholangiocarcinoma (ICC) is not clear. Therefore, we examine the impact of Medicaid expansion (ME) on access to treatment and outcomes of ICC. Methods We queried the National Cancer Database (NCDB) data for patients with a diagnosis of ICC (2010–2018). Difference-in-difference (DID) analysis was performed to assess the impact of January 2014 ME on curative-intent surgical resection, multimodal therapy, neoadjuvant chemotherapy, 30-day mortality, and overall survival (OS). Results Of the 2150 patients included in the study,1574 (73.2%) and 576 (26.8%) patients lived in non-ME and ME states, respectively. On adjusted DID, ME was independently associated with receipt of curative-intent surgical resection (DID coefficient: 0.05, 95% confidence interval [95% CI]: 0.04–0.06, p = 0.002) and multimodal therapy (DID coefficient: 0.08, 95% CI: 0.06–0.10, p = 0.004). In addition, ME was associated with improved OS in ME states (hazard ratio [HR]: 0.73, 95% CI: 0.62–0.87, p = 0.001) but not in non-ME states (HR: 0.95, 95% CI: 0.80–1.12, p = 0.536). Conclusion ME status consistently predicted increased utilization of care processes that improved ICC outcomes, including greater rates of curative-intent surgery and multimodal therapy..
| Medienart: |
Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:27 |
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| Enthalten in: |
Journal of gastrointestinal surgery - 27(2023), 7 vom: 18. Apr., Seite 1367-1375 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ahmed, Fasih A. [VerfasserIn] |
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| Links: |
Volltext [lizenzpflichtig] |
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| Anmerkungen: |
© The Society for Surgery of the Alimentary Tract 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. |
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| doi: |
10.1007/s11605-023-05674-0 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
OLC2144645213 |
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| 100 | 1 | |a Ahmed, Fasih A. |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Impact of Medicaid Expansion on the Treatment and Outcomes of Intrahepatic Cholangiocarcinoma |
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| 520 | |a Introduction The Affordable Care Act increased insurance coverage for patients residing in states that expanded Medicaid coverage, but its impact on the outcomes of intrahepatic cholangiocarcinoma (ICC) is not clear. Therefore, we examine the impact of Medicaid expansion (ME) on access to treatment and outcomes of ICC. Methods We queried the National Cancer Database (NCDB) data for patients with a diagnosis of ICC (2010–2018). Difference-in-difference (DID) analysis was performed to assess the impact of January 2014 ME on curative-intent surgical resection, multimodal therapy, neoadjuvant chemotherapy, 30-day mortality, and overall survival (OS). Results Of the 2150 patients included in the study,1574 (73.2%) and 576 (26.8%) patients lived in non-ME and ME states, respectively. On adjusted DID, ME was independently associated with receipt of curative-intent surgical resection (DID coefficient: 0.05, 95% confidence interval [95% CI]: 0.04–0.06, p = 0.002) and multimodal therapy (DID coefficient: 0.08, 95% CI: 0.06–0.10, p = 0.004). In addition, ME was associated with improved OS in ME states (hazard ratio [HR]: 0.73, 95% CI: 0.62–0.87, p = 0.001) but not in non-ME states (HR: 0.95, 95% CI: 0.80–1.12, p = 0.536). Conclusion ME status consistently predicted increased utilization of care processes that improved ICC outcomes, including greater rates of curative-intent surgery and multimodal therapy. | ||
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