Advertisement

PCN200 MEDICAID EXPANSION AND RACIAL INEQUITIES IN NEXT GENERATION SEQUENCING TESTING IN ONCOLOGY

      Objectives

      Racial minorities in the United States have inferior cancer outcomes. For patients with cancer, next generation sequencing (NGS) informs treatment decisions; while NGS use is increasing, it is unclear whether uptake disparities exist. This study investigated changes in racial inequity in NGS testing of cancer patients following the 2014-onwards Medicaid coverage expansion ushered by the Patient Protection and Affordable Care Act (ACA) passage, comparing states with (36/50) and without expanded coverage status.

      Methods

      Real-world patients with one of 10 cancer types and ≥2 documented visits from 1/1/2011 or 1/1/2013, depending on disease type, through 12/31/2017 in the Flatiron Health EHR-derived database were included in this exploratory retrospective study. Racial inequity was defined as the absolute percent difference in diagnosis-indexed NGS testing rates for black or African-American and white patients diagnosed in the time period. We compared the absolute percent difference in the pre-period (2011-2013) to the post-period (2014-2016) and to 2017 stratified by state Medicaid expansion status. Analyses were not adjusted for other covariates and potential confounders.

      Results

      We identified a cohort of 6,220 patients with abstraction-confirmed NGS testing (total N=49,915). Racial inequity in NGS testing use was observed in the pre-period (N=1,232) in Medicaid expansion and non-expansion states (-3.7% and -2.6% respectively). In the post-period (N=3,659), inequity dropped in expansion states (-1.6%) and grew in non-expansion states (-3.1%). Racial inequity in non-expansion states peaked in 2017 (16.9% vs 11.4%; Diff=-5.5%; N=637) while the racial inequity gap closed in expansion states in 2017 (17.6% vs 18.6%; Diff=1.0%; N=692).

      Conclusions

      This hypothesis-generating study suggests Medicaid expansion may be associated with a reduction in racial inequity of NGS testing in cancer patients. Further research is needed to determine drivers and significance of NGS testing disparities.