Medicaid expansion is associated with a higher likelihood of early diagnosis,resection, transplantation,and overall survival in patients with hepatocellular carcinoma |
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| Affiliation: | 1. Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA;2. Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA;1. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan;2. Department of Gastroenterological Surgery, Nagano Red Cross Hospital, 5-22-1, Wakasato, Nagano-shi, Nagano, 380-8582, Japan;3. Department of Digestive Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan;4. Division of Pathology, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan;1. Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy;2. Division of Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden;1. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan;2. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA;1. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands;2. Department of Surgery, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, Germany;3. Epidemiologist, Department of Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands;4. Department of Surgery, Erasmus MC, Rotterdam, the Netherlands;1. Centre Hépato-Biliaire, Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France;2. Institut National de La Santé et de La Recherche Médicale (INSERM) Unité 935, And Université Paris-Saclay, Villejuif, France;3. Université Paris-Saclay, Villejuif, France;4. Inserm UMR-S-MD A9, Hôpital Paul Brousse, Villejuif, France;5. Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India;6. Service de Radiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France;7. Département D''Anesthésie-Réanimation, Centre Hépato-Biliaire, Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France;8. Département de Chirurgie Hépato-Biliaire et Transplantation Hépatique, Assistance Publique – Hôpitaux de Paris, Hôpital Universitaire Pitié-Salpêtrière, Paris, France |
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| Abstract: | BackgroundWe examined the association between Medicaid expansion (ME) and the diagnosis, treatment, and survival of patients with hepatocellular carcinoma (HCC).MethodsWe identified patients with HCC <65yrs with Medicaid or without insurance within the National Cancer Database before (2010–2013) or after (2015–2017) ME with early (cT1) or intermediate/advanced (cT2-T4 or M1) disease.ResultsWe identified 4848 patients with HCC before and 4526 after ME. Prior to ME, there was no association between future ME status and diagnosis of early HCC (34.5% vs. 32.9%). There was no association between future ME status and treating early HCC with ablation, resection, or transplantation. Patients with early HCC in future ME states were less likely to die (HR = 0.81, 95% CI: 0.67–0.98). After ME, patients in ME states were more likely to be diagnosed with early HCC (39.2% vs. 32.1%). Patients with early disease in ME states were more likely to undergo resection (OR=1.78, 95% CI: 1.16–2.75) or transplantation (OR=3.20, 95% CI: 1.40–7.33). There was a further associated decrease in the hazard of death (HR=0.68, 95% CI: 0.54–0.86).ConclusionME was associated with early diagnosis of HCC. For early HCC, ME was associated with increased utilization of resection and transplantation and improvement in survival. |
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