Impact of the Mexican Healthcare Reform on Optimal Treatment Delivery, Survival, and Response Rates Among a Cohort of Patients with Diffuse Large B Cell Lymphoma in a Single National Reference Institution

• Published in: Blood 2023-11, Vol.142 (Supplement 1), p.7402-7402
• Main Authors: Gutiérrez Ramírez, Francisco Javier, Aviles, Alejandro, García-Pérez, Francisco Osvaldo, Lozano, Valentin, Candelaria, Myrna
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2023-189436

Introduction: The creation of Seguro Popular (SP) in Mexico, back in 2003, was the first step towards creating a universal healthcare system. After it was implemented, there was a 4-times boost in health spend and the creation of the Protection Fund Against Catastrophic Expenses, a fund meant for covering the costs of illnesses with a high financial burden, such as most cancers. As of January 2020, the Health Institute for Wellbeing (INSABI, Spanish acronym) has taken its place with promises to provide free health coverage for everyone. This scheme has been accompanied by multiple shortages of cancer medications due to its lack of planning and budget allocation. As a consequence, a proportion of lymphoma patients haven't been able to receive full treatment regimens. Our study aims to identify differences in survival and response rates among patients with diffuse large B cell lymphoma (DLBCL) receiving R-CHOP as first line treatment under SP and INSABI, in the National Cancer Institute (INCan) in Mexico City. Methods: This is a retrospective study where two groups with histologically documented DLBCL were compared. Group A consisted of a cohort of adult patients treated at INCan from 2011 to 2018 under the SP scheme, receiving full funding for diagnostic approach and treatment with R-CHOP as first line therapy. Group B consisted of a cohort of adult patients treated at INCan from 2020 to 2021 under INSABI's gratuity policy, receiving R-CHOP as first line therapy. Variables collected included sex, age at diagnosis, comorbidities, B-symptoms, molecular subtype, stage, bulky disease, and IPI, among others. Optimal treatment was evaluated and defined as the proportion of patients who received full drugs' dosage according to the recommendation of the attending physician. Response was assessed with 18F-FDG PET-CT according to the Lugano classification, and was defined as the proportion of patients with complete remission (CR) for all patients evaluable for response. Event free survival (EFS) was defined as time to relapse or progression during treatment. Overall survival (OS) was defined as time to death in years from the date of primary diagnosis. The significance of variation in the distribution of outcomes with healthcare regime (SP, INSABI) was assessed with Pearson's Chi-square tests or Fisher's Exact test as appropriate. Survival distributions were done with Kaplan-Meier methodology. Cox regression analysis was used to evaluate factors influencing on relaps