Insurance-based disparities impact survival outcomes in Waldenström macroglobulinemia within the United States

Abstract

Considerable healthcare resource utilization and financial burden have been associated with the treatment of WM; however, the impact of health insurance status on outcomes has not been previously reported. We conducted a National Cancer Database analysis of newly diagnosed cases of active WM between 2004 and 2017 to evaluate the impact of insurance status on outcomes. For patients <65 years old (n = 1249, male sex: 62.4%, median age: 58 years), significant insurance-based survival differences were observed on multivariable analysis; patients who were uninsured [n = 63; HR 3.11 (95%CI, 1.77–5.45), p < 0.001], on Medicaid [n = 87; HR 1.88 (95% CI, 1.01–3.48), p = 0.045], or on Medicare [n = 122; HR 2.78 (95%CI, 1.76–4.38), p < 0.001], had inferior survival compared to patients with private insurance (n = 977; reference). In patients ≥65 years, no insurance-based survival differences were found (p = 0.10). Overall, significant insurance-based outcome disparities exist in WM. Further work is desperately needed to systematically uncover and address these disparities.

Keywords:

• Non-Hodgkin lymphoma
• healthcare
• lymphoplasmacytic lymphoma
• Waldenström macroglobulinemia
• NCDB analysis

Acknowledgments

There is no acknowledgements or funding to report for this study.

Authors contributions

K.L.C and J.P designed this study, analyzed/interpreted the data, and wrote the manuscript. J.P.A, S.M.A, M.A.G, P.K, A.P, S.A., C.B.R, T.E.W, T.M.H, M.Q.L, R.A.K and R.S.G, made significant contributions in interpreting the data and writing the manuscript. All authors provided final approval of the manuscript and are accountable for all aspects of the work.

Disclosure statement

S.M.A receives research funding from: Bristol-Myers Squibb, Seattle Genetics, Affimed Therapeutics, Regeneron, Trillium Therapeutics, AI Therapeutics, ADC Therapeutics. M.A.G serves in a consulting/advisory role for: Prothena, Bristol-Myers Squibb, Sanofi. P.K serves in a consulting/advisory role for: Sanofi, and receives research funding from: Amgen, Takeda, Sanofi, Abbvie, GlaxoSmithKline, Sorrrento Therapeutics, Karyopharm Therapeutics, and Regeneron. S.A. serves in a consulting/advisory role for: Takeda, Celgene, Beigene, Oncopeptides, GlaxoSmithKline, and Sanofi, and receives research funding from: Pharmacyclics, Janssen Biotech, Cellectar, Phosplatin Therapeuticss, Bristol-Myers Squibb, Amgen, MedImmune, Xencor. T.E.W. serves in a consulting/advisory role for: Karyopharm Therapeutics, Celgene, Epizyme, Cellectar, Tessa Therapeutics, Portola Pharmaceuticals, ABC Therapeutics, and receives research funding from: Celgene, Acertta Pharma, Kura Oncology, Acrotech Biopharma, Karyopharm Therapeutics. T.M.H. serves on the scientific advisory board for: Eli Lilly & Co., Morphosys, Incyte, Biegene, Loxo Oncology, received research funding from Genentech, and serves on the data monitoring committee for: Seagen, and Tess Therapeutics. R.A.K serves in a consulting/advisory role for Celgene, Bristol-Myers Squibb, Pharmacyclics and Pfizer. J.P receives research funding from: Karyopharm Therapeutics and Biofourmis. The remaining authors have no disclosures to report.