{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T11:21:54Z","timestamp":1784892114531,"version":"3.55.0"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T00:00:00Z","timestamp":1710374400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Healthcare Research and Quality","award":["5T32 HS00003228"],"award-info":[{"award-number":["5T32 HS00003228"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Because the markups on cancer drugs vary by payor, providers\u2019 financial incentive to use high-price drugs is differential according to each patient\u2019s insurance type. We evaluated the association between patient insurer (commercial vs Medicaid) and the use of high-priced cancer treatments.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We linked cancer registry, administrative claims, and demographic data for individuals diagnosed with cancer in North Carolina from 2004 to 2011, with either commercial or Medicaid insurance. We selected cancers with multiple FDA-approved, guideline-recommended chemotherapy options and large price differences between treatment options: advanced colorectal, lung, and head and neck cancer. The outcome was a receipt of a higher-priced option, and the exposure was insurer: commercial versus Medicaid. We estimated risk ratios (RRs) for the association between insurer and higher-priced treatment using log-binomial models with inverse probability of exposure weights.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 812 patients, 209 (26%) had Medicaid. The unadjusted risk of receiving higher-priced treatment was 36% (215\/603) for commercially insured and 27% (57\/209) for Medicaid insured (RR: 1.31, 95% CI: 1.02-1.67). After adjustment for confounders the association was attenuated (RR: 1.15, 95% CI: 0.81-1.65). Exploratory subgroup analysis suggested that commercial insurance was associated with increased receipt of higher-priced treatment among patients treated by non-NCI-designated providers (RR: 1.53, 95% CI: 1.14-2.04).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Individuals with Medicaid and commercial insurance received high-priced treatments in similar proportion, after accounting for differences in case mix. However, modification by provider characteristics suggests that insurance type may influence treatment selection for some patient groups. Further work is needed to determine the relationship between insurance status and newer, high-price drugs such as immune-oncology agents.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/oncolo\/oyae035","type":"journal-article","created":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T22:32:55Z","timestamp":1710455575000},"page":"527-533","source":"Crossref","is-referenced-by-count":4,"title":["Commercial Versus Medicaid Insurance and Use of High-Priced Anticancer Treatments"],"prefix":"10.1093","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3639-3515","authenticated-orcid":false,"given":"Aaron P","family":"Mitchell","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center , New York, NY , United States"},{"name":"Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, NY , United States"},{"name":"Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill , Chapel Hill, NC , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan C","family":"Kinlaw","sequence":"additional","affiliation":[{"name":"Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill , Chapel Hill, NC , United States"},{"name":"Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill , Chapel Hill, NC , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Peacock-Hinton","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, NC , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacie B","family":"Dusetzina","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Vanderbilt University School of Medicine , Nashville, TN , United States"},{"name":"Vanderbilt-Ingram Cancer Center , Nashville, TN , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron N","family":"Winn","sequence":"additional","affiliation":[{"name":"University of Illinois at Chicago , Chicago, IL , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna K","family":"Sanoff","sequence":"additional","affiliation":[{"name":"Department of Hematology\/ Oncology, School of Medicine, University of North Carolina at Chapel Hill , Chapel Hill, NC , United States"},{"name":"Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill , Chapel Hill, NC , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L","family":"Lund","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, NC , United States"},{"name":"Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill , Chapel Hill, NC , United 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