Evidence map›Paper›PMID 38484395›Full record

ArticleThe oncologist2024

Commercial Versus Medicaid Insurance and Use of High-Priced Anticancer Treatments.

Aaron P Mitchell, Alan C Kinlaw, Sharon Peacock-Hinton, Stacie B Dusetzina, Aaron N Winn, Hanna K Sanoff, Jennifer L Lund

Abstract read
In one paragraph

Article in The oncologist, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Observational
  2. Article
  3. Use of Low-Value Cancer Treatments in Medicare Advantage Versus Traditional Medicare.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Aaron P MitchellDepartment of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States.ORCID 0000-0003-3639-3515
Alan C KinlawCecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Sharon Peacock-HintonDepartment of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Stacie B DusetzinaDepartment of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, United States.
Aaron N WinnUniversity of Illinois at Chicago, Chicago, IL, United States.
Hanna K SanoffDepartment of Hematology/ Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Jennifer L LundDepartment of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.

Funding

X-RAY CRYSTALLOGRAPHYP30CA008748 · NCI · SLOAN-KETTERING INSTITUTE FOR CANCER RES · PI Hongbiao Carl Lekaye · 1985 to 2026
$347.4M
UNC-CH TRAINING PROGRAM IN HEALTH SERVICES RESEARCHT32HS000032 · AHRQ · UNIV OF NORTH CAROLINA CHAPEL HILL · PI HOLMES, GEORGE M · 1989 to 2024
$8.2M
AHRQ HHS T32 HS000032Healthcare Research and Quality 5T32 HS00003228NCI NIH HHS P30 CA008748
6 · The paper itself

Abstract

backgroundBecause the markups on cancer drugs vary by payor, providers' financial incentive to use high-price drugs is differential according to each patient's insurance type. We evaluated the association between patient insurer (commercial vs Medicaid) and the use of high-priced cancer treatments. MATERIALS AND

methodsWe linked cancer registry, administrative claims, and demographic data for individuals diagnosed with cancer in North Carolina from 2004 to 2011, with either commercial or Medicaid insurance. We selected cancers with multiple FDA-approved, guideline-recommended chemotherapy options and large price differences between treatment options: advanced colorectal, lung, and head and neck cancer. The outcome was a receipt of a higher-priced option, and the exposure was insurer: commercial versus Medicaid. We estimated risk ratios (RRs) for the association between insurer and higher-priced treatment using log-binomial models with inverse probability of exposure weights.

resultsOf 812 patients, 209 (26%) had Medicaid. The unadjusted risk of receiving higher-priced treatment was 36% (215/603) for commercially insured and 27% (57/209) for Medicaid insured (RR: 1.31, 95% CI: 1.02-1.67). After adjustment for confounders the association was attenuated (RR: 1.15, 95% CI: 0.81-1.65). Exploratory subgroup analysis suggested that commercial insurance was associated with increased receipt of higher-priced treatment among patients treated by non-NCI-designated providers (RR: 1.53, 95% CI: 1.14-2.04).

conclusionsIndividuals with Medicaid and commercial insurance received high-priced treatments in similar proportion, after accounting for differences in case mix. However, modification by provider characteristics suggests that insurance type may influence treatment selection for some patient groups. Further work is needed to determine the relationship between insurance status and newer, high-price drugs such as immune-oncology agents.

Indexed as

MedicaidAdultAgedAntineoplastic AgentsFemaleHumansInsurance, HealthMaleMiddle AgedNeoplasmsNorth CarolinaUnited StatesAntineoplastic Agentsantineoplastic agentsclinicalfee-for-service plansincentiveinsurance coveragepractice patternreimbursement

Identifiers

PMID38484395
PMCPMC11144993

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.