Impact of Medicaid Expansion on the Treatment and Outcomes of Intrahepatic Cholangiocarcinoma

Fasih A Ahmed; Sameer A Khan; Apoorve Nayyar; Hassan Aziz

doi:10.1007/s11605-023-05674-0

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Impact of Medicaid Expansion on the Treatment and Outcomes of Intrahepatic Cholangiocarcinoma

Journal article

Peer reviewed

Impact of Medicaid Expansion on the Treatment and Outcomes of Intrahepatic Cholangiocarcinoma

Fasih A Ahmed, Sameer A Khan, Apoorve Nayyar and Hassan Aziz

Journal of gastrointestinal surgery, Vol.27(7), pp.1367-1375

07/01/2023

DOI: 10.1007/s11605-023-05674-0

PMID: 37072665

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Abstract

The Affordable Care Act increased insurance coverage for patients residing in states that expanded Medicaid coverage, but its impact on the outcomes of intrahepatic cholangiocarcinoma (ICC) is not clear. Therefore, we examine the impact of Medicaid expansion (ME) on access to treatment and outcomes of ICC. We queried the National Cancer Database (NCDB) data for patients with a diagnosis of ICC (2010-2018). Difference-in-difference (DID) analysis was performed to assess the impact of January 2014 ME on curative-intent surgical resection, multimodal therapy, neoadjuvant chemotherapy, 30-day mortality, and overall survival (OS). Of the 2150 patients included in the study,1574 (73.2%) and 576 (26.8%) patients lived in non-ME and ME states, respectively. On adjusted DID, ME was independently associated with receipt of curative-intent surgical resection (DID coefficient: 0.05, 95% confidence interval [95% CI]: 0.04-0.06, p = 0.002) and multimodal therapy (DID coefficient: 0.08, 95% CI: 0.06-0.10, p = 0.004). In addition, ME was associated with improved OS in ME states (hazard ratio [HR]: 0.73, 95% CI: 0.62-0.87, p = 0.001) but not in non-ME states (HR: 0.95, 95% CI: 0.80-1.12, p = 0.536). ME status consistently predicted increased utilization of care processes that improved ICC outcomes, including greater rates of curative-intent surgery and multimodal therapy.

Bile Duct Neoplasms - surgery

Bile Ducts, Intrahepatic - surgery

Cholangiocarcinoma - surgery

Follow-Up Studies

Humans

Insurance Coverage

Medicaid

Patient Protection and Affordable Care Act

Retrospective Studies

Treatment Outcome

United States

Details

Title: Subtitle: Impact of Medicaid Expansion on the Treatment and Outcomes of Intrahepatic Cholangiocarcinoma
Creators: Fasih A Ahmed - University Hospitals of Cleveland
Sameer A Khan - Hospital of the University of Pennsylvania
Apoorve Nayyar - University of Iowa
Hassan Aziz - University of Iowa Hospitals and Clinics
Resource Type: Journal article
Publication Details: Journal of gastrointestinal surgery, Vol.27(7), pp.1367-1375
DOI: 10.1007/s11605-023-05674-0
PMID: 37072665
ISSN: 1091-255X
eISSN: 1873-4626
Language: English
Date published: 07/01/2023
Academic Unit: Surgery
Record Identifier: 9984701657502771

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