Time to Insurance Approval in Private and Public Payers Does Not Influence Survival in Patients Who Undergo Hematopoietic Cell Transplantation

Bhatt, Vijaya Raj; Loberiza, Fausto R.; Schmit-Pokorny, Kim; Lee, Stephanie J.

doi:10.1016/j.bbmt.2016.03.008

Cited by 15 publications

(10 citation statements)

References 25 publications

(32 reference statements)

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“…Insurance status was also strongly correlated with the likelihood of receiving HCT. Uninsured patients, as well as Medicare/Medicaid patients were much less likely to receive HCT than private insurers, consistent with a prior report [26]. These racial and educational factors can impact the receipt of HCT in many ways.…”

Section: Discussionsupporting

confidence: 83%

Socioeconomic and health system factors associated with lower utilization of hematopoietic cell transplantation in older patients with acute myeloid leukemia

Bhatt

Chen

Gyawali

et al. 2018

Bone Marrow Transplant

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Receipt of hematopoietic cell transplantation (HCT) can improve overall survival in older patients with intermediate or high-risk acute myeloid leukemia (AML); however, utilization of HCT is poor. It is important to understand the factors that affect the receipt of HCT in a real-world setting among the older patients. We utilized the National Cancer Database to determine receipt of HCT in older patients (61-75 years) with intermediate or high-risk AML reported between 2003 and 2012. Multivariate logistic regression analysis was used to determine factors associated with receipt of HCT. Only 5.5% of older patients (n = 17,555) underwent HCT. Factors associated with a lower likelihood of receiving HCT included receipt of care in a non-academic hospital, race other than white, older age, Charlson comorbidity score of ≥1, uninsured status, Medicaid or Medicare insurance, and lower educational status. The receipt of HCT in older patients is low and varies based on biological as well as non-biologic factors, such as hospital type, insurance, and educational status. Nationwide efforts to improve access to HCT for appropriate patients are necessary.

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Section: Discussionsupporting

confidence: 83%

Socioeconomic and health system factors associated with lower utilization of hematopoietic cell transplantation in older patients with acute myeloid leukemia

Bhatt

Chen

Gyawali

et al. 2018

Bone Marrow Transplant

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“…The use of HCT was low among uninsured patients and Medicare/Medicaid patients, compared to patients with private insurance. The association of private insurance coverage with higher rates of HCT is largely consistent with our prior study [15]. These important results highlight the significant impact of nonbiologic factors on the receipt of HCT and cancer care disparity.…”

Section: Discussionsupporting

confidence: 88%

Use of hematopoietic cell transplantation in younger patients with acute myeloid leukemia: A National Cancer Database Study

Bhatt

Chen

Lee

2018

Bone Marrow Transplant

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Younger patients with intermediate or high-risk acute myeloid leukemia (AML) obtain overall survival benefit from the upfront use of hematopoietic cell transplantation (HCT). We queried the National Cancer Database to study 19,897 younger patients (18-60 years) with intermediate or high-risk AML reported between 2003-2012. Multivariable logistic regression analysis was performed to identify variables associated with the utilization of HCT. Approximately 18.5% of younger patients received HCT as a part of initial therapy. A lower rate of utilization of HCT was associated with receipt of care in a non-academic hospital, African American race, male sex, age group 50-60 years, Charlson comorbidity score of ≥1, uninsured status, Medicaid or Medicare insurance, and lower educational or income status. The use of HCT in younger patients varies based on non-biologic factors such as race, hospital type, insurance, educational, and income status. Socioeconomic and health system factors contribute to disparity in the uptake of HCT in the US.

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“…Timing of approvals can vary between plans. 30 For families managing the decline in their child's health during the last year of life, coordinating benefits between insurance plans may not be a priority. Thus, the administrative burden of private insurance and Medicaid insurance for children with complex chronic conditions might be a hindrance to children obtaining hospice care.…”

Section: Discussionmentioning

confidence: 99%

Multiple Complex Chronic Conditions and Pediatric Hospice Utilization among California Medicaid Beneficiaries, 2007–2010

Lindley

2017

Journal of Palliative Medicine

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Background: Over 42,000 children die each year in the United States, including many with multiple complex chronic conditions (MCCCs), but little is known about whether the presence of MCCCs influences families to utilize pediatric hospice care. Objective: The study objective was to examine the relationship between MCCCs and pediatric hospice utilization among Medicaid beneficiaries. Methods: A retrospective, longitudinal cohort design was conducted with 2007-2010 California Medicaid data to examine the relationship between MCCCs (i.e., two or more MCCCs) and pediatric hospice utilization (i.e., hospice enrollment, hospice length of stay). Multivariate logistic regression with year fixed effects examined the effect of MCCCs on hospice enrollment, and negative binomial model with year fixed effects explored the relationship between MCCCs and hospice length of stay. Results: More than 10% of children enrolled in hospice care with an average length of stay of approximately three days. In the study sample, 48.6% of the children had MCCCs. MCCCs were not significantly related to hospice enrollment. However, children with MCCCs (incidence rate ratios = 4.25, p < 0.01) were associated with an increase in the number of days in hospice care. Conclusions: This study demonstrated that children with MCCCs have limited hospice care utilization at end of life. Future research is needed to explore barriers to hospice care for children with MCCCs.

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Time to Insurance Approval in Private and Public Payers Does Not Influence Survival in Patients Who Undergo Hematopoietic Cell Transplantation

Cited by 15 publications

References 25 publications

Socioeconomic and health system factors associated with lower utilization of hematopoietic cell transplantation in older patients with acute myeloid leukemia

Socioeconomic and health system factors associated with lower utilization of hematopoietic cell transplantation in older patients with acute myeloid leukemia

Use of hematopoietic cell transplantation in younger patients with acute myeloid leukemia: A National Cancer Database Study

Multiple Complex Chronic Conditions and Pediatric Hospice Utilization among California Medicaid Beneficiaries, 2007–2010

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