Relationship Between Insurance Type and Survival in Multiple Myeloma

A study published in Cancers examined whether type of insurance is independently associated with overall survival (OS) among patients with multiple myeloma (MM).

The investigators used the National Cancer Database to identify 117,926 patients with MM who were diagnosed between 2005 and 2014. The median patient age was 67 years. At the time of diagnosis, 53% of patients had Medicare, 35% had private insurance, 5.4% had Medicaid, 1% had other government insurance, and 3.2% did not have insurance.

Compared with those who had Medicare or private insurance, patients who had Medicaid or were uninsured were significantly more likely to live in areas with a median annual income of less than $46,000. Most patients (96%) were treated in facilities located within 120 miles of their residence, although traveling more than 120 miles was more common for patients with private insurance than Medicare (5.7% vs. 3%; P<0.0001). One-third of patients with Medicare were treated at academic institutions compared with half of patients with private insurance or Medicaid (P<0.001).

The researchers also assessed variability in rates of allogeneic hemopoietic cell transplantation (alloHCT) among the different insurance types. For patients aged younger than 65 years, one-third of those with private insurance underwent transplant compared with 20% of patients with Medicare (P<0.0001). Privately insured patients aged older than 65 years were also more likely to receive alloHCT than their counterparts with Medicare (11% vs. 6%, respectively; P<0.0001).

Overall, patients aged older than 65 years with private insurance had a higher average OS than those with Medicare (42 months vs. 31 months, respectively; P<0.0001). Treatment in an academic institution was associated with increased survival (hazard ratio [HR], 1.49; 95% confidence interval [CI], 1.39-1.59). Other factors significantly associated with improved OS were younger age, fewer comorbidities, and residing in an area with a higher median income.

After adjustment, mortality rates of patients with Medicare were not significantly different from those with private insurance, but the mortality hazard remained higher for patients with Medicaid (HR, 1.59; 95% CI, 1.36-1.87) or without insurance (HR, 1.62; 95% CI, 1.32-1.99) compared with privately insured patients.

In conclusion, the researchers wrote, “Economic factors and treatment facility type play an important role in the survival of [patients with] MM.”