Medicaid Expansion Linked to Earlier Detection of Liver Cancer, Fewer Deaths, UH Study Finds

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UH Clinical Update | November 2022

A research team from University Hospitals is adding to the growing literature on the benefits of expanding Medicaid under the Affordable Care Act.

Researchers here used patient data from the National Cancer Database (NCDB) to measure the impact of Medicaid expansion on patients diagnosed with hepatocellular carcinoma (HCC), comparing outcomes for patients living in states that expanded Medicaid with those living in states that did not.

Results show that patients living in Medicaid expansion states were less likely to die of the disease than were other patients. In addition, HCC patients in states that expanded Medicaid were more likely to have their disease diagnosed at an early stage and undergo resection or liver transplantation, when compared with other patients. The research team’s findings were recently published in the journal HPB.

Lee Ocuin, MDLee Ocuin, MD

Why it matters: Primary liver cancer is one of the leading causes of cancer-related mortality in the United States, with estimated 30,230 deaths in 2021 and a five-year survival rate of less than 20 percent. At the same time, patients diagnosed with early HCC have a better prognosis and are more likely to benefit from potentially curative interventions, such as ablation, resection and transplantation.

“We know that early detection and treatment is key with HCC,” says Lee M. Ocuin, MD, surgical oncologist with UH Seidman Cancer Center and Assistant Professor, Case Western Reserve University School of Medicine, and senior author of the new study. “Now we know that Medicaid expansion may be helping to facilitate that.”

Meeting a Research Need

These new findings fill a gap in the existing knowledge base on HCC and Medicaid expansion, Dr. Ocuin says.

“There is scant literature analyzing the association between Medicaid expansion and the diagnosis, management received, and survival outcomes of HCC,” he says. “One of the many goals of Medicaid expansion is to improve the rate of early detection of cancer. Given the limited advances in development of novel therapeutics for intermediate/advanced HCC, our primary aim in this study was to examine the association between Medicaid expansion status and diagnosis of early HCC. Our secondary aims included exploring the associations between Medicaid expansion status and the utilization of treatment approaches, as well as survival outcomes for patients with HCC.”

Study Methods and Results

For the study, Dr. Ocuin and his UH colleagues analyzed data from the NCDB for patients diagnosed with HCC who were either uninsured or covered by Medicaid expansion. Patients were divided into two large, consistent groups -- Medicaid expansion (19 states) or non-Medicaid expansion (19 states).

A total of 9374 patients with HCC were included in the analysis, of whom 4848 were diagnosed prior to Medicaid expansion (2010–2013) and 4526 patients were diagnosed after Medicaid expansion (2015–2017).

Results show a significant role for Medicaid expansion in improved early detection of HCC. Before Medicaid expansion, there was no difference between the two groups of states and likelihood of diagnosis of early HCC. However, after implementation of Medicaid expansion, patients who lived in states that expanded coverage were more likely to be diagnosed with early HCC (39.2% vs. 32.1%.) In addition, following the adoption of Medicaid expansion, patients with early HCC living in Medicaid expansion states were more likely to undergo resection (17.2% vs. 8.6%,) or transplantation (7.1% vs. 2.6%), when compared with patients in non-Medicaid expansion states.

“Following Medicaid expansion implementation, patients with HCC in states that expanded Medicaid were more likely to be diagnosed with early-stage disease and to undergo resection or transplantation,” Dr. Ocuin says. “Also, early HCC patients in these states had a lower associated hazard of death pre-expansion that was reduced further following implementation of Medicaid expansion.”

Dr. Ocuin says he hopes these findings will help inform the ongoing national conversation on the merits of Medicaid expansion.

“While these associations are likely multifactorial, our findings reinforce the importance of insurance coverage to health care access and treatment, and we must continue efforts to expand health care on a state and national level,” he says.

Medicaid expansion is associated with a higher likelihood of early diagnosis, resection, transplantation, and overall survival in patients with hepatocellular carcinoma. HPB, 2022-09-01, Volume 24, Issue 9, Pages 1482-1491.

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