Selection of active surveillance in Medicaid patients: Results from the Michigan Urological Surgery Improvement Collaborative.

Abstract

302 Background: Active surveillance (AS) is the preferred treatment for low-risk prostate cancer. Insurance coverage and cost sharing often influence treatment choices for providers and patients. The impact of insurance payer, specifically Medicaid, on treatment selection in prostate cancer remains understudied. Methods: We identified patients with biopsy-proven prostate cancer from the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry, a statewide quality improvement collaborative, from 2016-2021. We captured risk category, insurance payer (Medicaid vs. private insurance), and treatment (AS vs. primary treatment). Watchful waiting rates were under 2% in both payer groups; these patients were excluded from analysis. We used logistic regression to assess the correlation between payer status and treatment choice by prostate cancer risk group. Results: We identified 38,663 patients. Most patients had private insurance (51%), followed by Medicare (45%) and Medicaid (3%). Median age was 62 (IQR 58 – 66) for privately insured patients and 60 (IQR 56 – 63) for Medicaid patients. Among patients with low-risk disease, 65% of privately insured patients and 67% of Medicaid patients elected for AS. AS for favorable intermediate-risk prostate cancer was also similar across the payer groups (private 20%, Medicaid 19%). In an adjusted analysis Medicaid and privately insured patients did not demonstrate different odds of AS (OR 0.99 (95%CI 0.71 – 1.40), p > 0.9). No significant differences in treatment selection were noted in favorable or unfavorable intermediate-risk patients (Table). Conclusions: Our analysis, from a granular statewide registry, suggests that Medicaid patients undergo similar treatment patterns to commercially insured patients. This suggests that insurance status may not drive AS selection in our cohort. Our work points towards not only the increased adoption of AS, but also its adoption across payers. [Table: see text]