Health-insurance status is a determinant of the stage at presentation and of cancer control in European men treated with radical prostatectomy for clinically localized prostate cancer.
OBJECTIVE
To determine whether health-insurance status might result in more localized stage at presentation, more favourable stage at surgery and in a lower rate of biochemical recurrence (BCR), in patients diagnosed with prostate cancer and treated with radical prostatectomy (RP), as despite uninhibited access to healthcare, private and public health insurance are available in most European countries.


METHODS
In all, 4442 consecutive men had RP in two large European centres, of whom 2372 had public and 2070 had private health insurance. The groups were compared for several variables according to insurance status (private vs public). Means and proportions tests were complemented with logistic regression or Kaplan-Meier analyses.


RESULTS
Serum prostate-specific antigen level (P < 0.001), clinical stage (P < 0.001), pathological Gleason sum (P = 0.02), positive surgical margin rate (18.4% vs 25.4%, P < 0.001), extracapsular extension rate (17.7% vs 20.0%, P = 0.047) and seminal vesicle invasion rate (9.6% vs 11.6%, P = 0.04) were more favourable in privately insured patients. Conversely, the rate of lymph-node involvement was higher in those with private than public insurance (4.4% vs 3.3%, P = 0.045). In univariate analyses addressing pathological variables, private insurance was invariably protective (all P < 0.05). The Kaplan-Meier analyses showed that privately insured patients had a lower rate of BCR after RP (log-rank P = 0.017).


CONCLUSIONS
Despite uninhibited access to healthcare, insurance status represents a rate-limiting variable, which affects stage at presentation and the outcome of cancer control.
Gallina
Andrea
A
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada.
Karakiewicz
Pierre I
PI
Chun
Felix K-H
FK
Briganti
Alberto
A
Graefen
Markus
M
Montorsi
Francesco
F
Walz
Jochen
J
Jeldres
Claudio
C
Erbersdobler
Andreas
A
Salonia
Andrea
A
Suardi
Nazareno
N
Dehò
Federico
F
Schlomm
Thorsten
T
Scattoni
Vincenzo
V
Haese
Alexander
A
Heinzer
Hans
H
Valiquette
Luc
L
Rigatti
Patrizio
P
Huland
Hartwig
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005060:Europe; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D011468:Prostatectomy / Q000191:economics / Q000379:methods*; D011471:Prostatic Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome