Health Insurance Boosts Survival Odds in Patients with Leukemia

A recent study found that insurance-based healthcare improves survival outcomes, but may not improve compliance to treatment.

Poor treatment outcomes are typically associated with poor adherence to treatment, belief in alternate medicine, lack of knowledge, cultural and social factors, high infection rates, and financial difficulties.

The study, published by Indian Journal of Medical and Paediatric Oncology, enrolled 179 patients from Andhra Padesh over 10 years old who were diagnosed with acute lymphoblastic leukemia (ALL) and were also treated from 2003 to 2011 in order to analyze how insurance-based healthcare and treatment compliance effected outcomes.

Researchers studied hospital records and tumor registry records. For diagnosis, a complete blood picture, hepatic and renal function tests, bone marrow aspiration and biopsy, immunophenotyping, karyotyping, and cytogenics were all included.

Other factors like treatment type, compliance, and outcome were all analyzed.

Patients were then stratified into groups based on whether or not state health insurance scheme (SHI) was created when they received treatment. Group A included 87 patients who received treatment prior to SHI from years 2003 to 2007, while group B included 92 patients who received treatment after the introduction of SHI from 2008 to 2011.

Overall survival was defined in this study as the day of entry into the study to the time of death or lost to follow-up. Defaulters were defined as patients who discontinued treatment or were lost to follow-up.

Lack of compliance was defined as a delay in a hospital visit or failure to consecutively take medication as prescribed.

Occurrences such as death, default, relapse, and lost to follow-up were defined as events in this study.

Researchers found that group A patients mostly received treatment without cashless or reimbursable government or employer-provided insurance, while group B patients mostly received treatment with assistance from SHI and other insurance plans and other government employees with reimbursement facility, according to the study.

Group A patients received protocol A, MCP 841, MCP 841 without l-asparaginase. A majority of group B patients received MCP 841 protocol followed by HYPER and CVAD, which are BFM protocols.

Researchers also found that immunophenotyping and cytogenetics were done in more patients in group B than in group A.

Risk factors such as lymphadenopathy, hepatosplenomegaly, and high total leukocyte count were similar in both groups, however, group A had more patients with anemia. Induction outcomes and overall compliance were similar in both groups.

Group A has more defaulters compared with group B. Group B patients also had less relapses and events than patients in group A. Compliance was seen to be similar in both groups.

Researchers noted that out of the patients who relapsed, 11 out of 45 in group A and 9 out of 35 in group B received second-line chemotherapy treatment. In group A, overall survival at 3 years was 17% and was 24% in group B.

Median survival and overall survival at 3 years was higher in group B, but the study found these results were not statistically significant.

In both groups, compliance to treatment resulted in higher overall survival rates.

Overall, patients in group B utilized modern diagnostics and therapeutic facilities likely due to greater insurance support. Patients in group B were also less likely to relapse or have an event compared with patients in group A.

Insurance-based healthcare systems have been shown to improve the treatment outcomes and utilization of modern diagnostic facilities in group B patients. However, poor compliance still happened despite financial assistance. Researchers concluded that more alternative strategies should be considered to improve compliance.