Impact of Insurance Status on Survival Outcomes in Metastatic RCC

A recent analysis of data from 2 National Cancer Institute–designated cancer centers aimed to determine the effect of insurance status on progression-free survival (PFS) and overall survival (OS) for patients receiving first-line systemic therapy for metastatic renal cell carcinoma (mRCC).

A total of 645 patients who were diagnosed with mRCC between 1990 and 2022 were retrospectively identified through institutional databases. Patients were grouped based on primary insurance type and secondary insurance status. The Kaplan-Meier method was used to determine PFS and OS, and results were compared using log-rank tests on the basis of insurance status. Univariable and multivariable models were used to examine the impact of insurance status on survival outcomes.

Of the 645 patients identified, 344 (53.3%) had Medicare as their primary insurance, 250 (38.8%) had private insurance, and 51 (7.9%) had Medicaid or no insurance. Patients who had Medicare were found to have significantly better PFS (hazard ratio [HR], 0.698; 95% CI, 0.502-0.971; P=0.033) than those with Medicaid or no insurance, and patients with private insurance had similar PFS (HR, 1.017; 95% CI, 0.737-1.404; P=0.917).

Secondary coverage was also linked to significantly better PFS, but not OS, when compared with primary coverage alone (HR, 0.812; 95% CI, 0.674-0.978; P=0.028; HR, 1.025; 95% CI, 0.822-1.279; P=0.824, respectively). Patients with Medicare had a lower risk of death compared with those with Medicaid or no insurance (HR, 0.495; 95% CI, 0.336-0.730; P<0.001), but no significant difference in OS  was observed between private insurance and Medicaid/no insurance groups (HR, 0.955; 95% CI, 0.660-1.382; P=0.807).

Patients with mRCC with Medicare have significantly better survival rates compared with patients who receive Medicaid or have no insurance. Having secondary insurance was linked to better PFS compared with having primary insurance alone.