University of Pennsylvania West Chester, PA, United States
A. A. Konski1, M. Iocolano1, N. Yegya-Raman1, R. Cohen2, C. Langer2, C. Friedes1, K. A. Cengel1, W. P. Levin1, M. J. LaRiviere1, J. D. Bradley1, and S. J. Feigenberg1; 1Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 2Department of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
Purpose/Objective(s): Proton beam therapy (PBT) use is limited by availability of PBT units and reimbursement. Health inequity in the use of PBT can exist based upon insurance coverage and access to PBT units. The concentration index (CI) is one measure used to quantify health inequity. CI use in identifying health inequity as it pertains to PBT use has not been documented to date. The purpose of this analysis is to examine the sociodemographic factors associated with PBT versus conventional radiotherapy (CRT) receipt and perform a health equity analysis in patients with LA-NSCLC. Materials/
Methods: Pts with LA-NSCLC treated between January 2011 and December 2021 at an academic medical center were reviewed retrospectively. Primary endpoint was treatment with PBT. Secondary endpoint was whether a health inequity existed according to the CI. Logistic regression analysis was used to determine any association between use of PBT and various sociodemographic variables including age, race, gender, median household income, and insurance type (Medicare vs other). Differences between continuous variables were investigated via a two-sided t-test and categorical variables via chi-square test. The Wagstaff correction of the CI was used to determine health inequity. The R statistical package was used for all statistical analyses (https://www.R-project.org/). Results: Of a total of 594 pts, 293 received PBT and 301 received CRT. Pts treated with PBT were older, 69.7 vs 64, p<0.001, had higher median household income, $84,254 vs $74,310, p<0.001, were more likely to be White, p<0.001, live further away from the center, p=0.023 and had Medicare insurance, p<0.001. Univariate analysis found age, race, income, distance, and insurance type to predict significantly for PBT use. On multivariate analysis, only Medicare, (p<0.001) predicting for PBT use. The CI was 0.178 (95% CI: 0.086-.27). A positive Concentration Index indicates a higher proportion of use of PBT among financially better off pts. Conclusion: This is the first analysis to show that pts with Medicare insurance were more likely to receive PBT for LA-NSCLC. This result is unsurprising, as most commercial insurance plans do not regularly reimburse the use of PBT. A positive CI indicates a disproportionate concentration of PBT use among the financially better off. Although distance to the proton beam center was longer in pts receiving PBT, there was no correlation between distance and income. Lower income pts may not have the resources to research and seek PBT. These results need confirmation in a larger dataset with a more diverse pt population. Further interventions are needed to lessen inequity and provide access to unique technologies to everyone.
