Treatment Access among Younger Medicaid Beneficiaries with Multiple Myeloma

• Published in: Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2024-08
• Main Authors: Fiala, Mark A., Ji, Mengmeng, Shih, Yi-Hsuan, Huber, John, Wang, Mei, Johnson, Kimberly J., Gasoyan, Hamlet, Wang, Rong, Colditz, Graham A., Wang, Shi-Yi, Chang, Su-Hsin
• Format: Article
• Language: English
• Subjects: Access to care; Disparities; Disparity; Health inequities; Social determinants of health
• ISSN: 2152-2650; 2152-2669; 2152-2669
• DOI: 10.1016/j.clml.2024.07.017

Continuous Medicaid coverage prior to a cancer diagnosis has been associated with earlier detection and better outcomes, for patients with solid tumors. In this study, we aimed to determine if this was observed among patients with multiple myeloma, a hematologic cancer where there are no routine screening tests and most are diagnosed through acute medical events. This is an analysis of the Merative MarketScan Multistate Medicaid Database, a claims-based dataset. In total, 1105 patients < 65 years old were included in the analyses. Among them, 66% had continuous enrollment (at least 6 months enrollment prior to myeloma), and 34% had discontinuous enrollment (2-6 months enrollment prior to myeloma). Multivariable Cox regression was used to estimate the association between continuous enrollment status and receipt of myeloma treatment within 1 year of index date. Only 54% of all Medicaid enrollees received myeloma therapy and only 12% received stem cell transplant within the 1st year. Those with continuous enrollment were less likely to receive any treatment (adjusted hazard ratio [aHR] 0.59; 95% confidence interval [CI] 0.59-0.70; P < .001) and to receive stem cell transplant (aHR 0.51; 95% CI 0.32-0.81; P = .005). Patients with continuous Medicaid coverage prior to diagnosis were less likely to receive myeloma therapy. Future studies should examine whether myeloma patients with continuous Medicaid enrollment have more chronic financial instability and/or higher medical needs and, thus, have higher barriers to care. Continuous Medicaid enrollment before cancer diagnosis has been associated with earlier diagnosis and treatment for solid tumors. We sought to determine if this observation extends to multiple myeloma. In this analysis of a commercial Medicaid database, we identified 1105 patients with multiple myeloma. Patients with continuous Medicaid enrollment for 6 or month prior were less likely to receive treatment.