Abstract
Metastatic breast cancer (MBC) patient outcomes may vary according to distinct health care payers and different countries. We compared 291 Alberta (AB), Canada and 9429 US patients < 65 with de novo MBC diagnosed from 2010 through 2014. Data were extracted from the provincial Breast Data Mart and from the National Cancer Institute’s SEER program. US patients were divided by insurance status (US privately insured, US Medicaid or US uninsured). Kaplan-Meier and log-rank analyses were used to assess differences in OS and hazard ratios (HR) were estimated using Cox models. Multivariate models were adjusted for age, surgical status, and biomarker profile. No difference in OS was noted between AB and US patients (HR = 0.92 (0.77–1.10), p = 0.365). Median OS was not reached for the US privately insured and AB groups, and was 11 months and 8 months for the US Medicaid and US uninsured groups, respectively. The 3-year OS rates were comparable between US privately insured and AB groups (53.28% (51.95–54.59) and 55.54% (49.49–61.16), respectively). Both groups had improved survival (p < 0.001) relative to the US Medicaid and US uninsured groups [39.32% (37.25–41.37) and 40.53% (36.20–44.81)]. Our study suggests that a universal health care system is not inferior to a private insurance-based model for de novo MBC.
Highlights
In North America, it is estimated that one out of eight women will develop breast cancer during their lifetime [1]
Our study suggests that a universal health care system is not inferior to a private insurance-based model for de novo Metastatic breast cancer (MBC)
The Breast Data Mart (BDM) is a repository of information on all patients diagnosed with breast cancer from 1 January 2004 onwards in the province of Alberta, Canada
Summary
In North America, it is estimated that one out of eight women will develop breast cancer during their lifetime [1]. Of these women, about 5% will be diagnosed with de novo stage IV (metastatic) disease [2]. Median and 5-year relative survival amongst patients with de novo stage IV breast cancer have been increasing [3,4]. In the United States (US), health insurance is either privately funded or governmentfunded, through Medicaid and Medicare, for low-income individuals and those ≥ 65 years, respectively [6]. There is substantial variability in health care coverage amongst the different insurance policies [7]. Despite the Affordable Care Act (ACA) becoming law in
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