title: Time to Insurance Approval in Private and Public Payers Does Not Influence Survival in Patients Who Undergo Hematopoietic Cell Transplantation.
abstract: In the United States, insurance status has been implicated as a barrier to obtaining timely treatment. In this retrospective cohort study of 521 patients who underwent first hematopoietic cell transplantation (HCT), we investigated the association between timeliness of HCT and overall survival. Timeliness was operationally defined in the following 3 ways: (1) payer approval, from request for approval to actual payer approval; (2) transplantation speed, from payer approval to time of actual HCT; and (3) total time, from request for approval to HCT. Patients with private insurance had longer time to payer approval (P < .0001) than those with public payers but shorter time from approval to actual HCT (P < .0001) and total time to HCT (P < .0001). Multivariate Cox regression showed no significant differences in risk of death between slow and fast times in the 3 indices of timeliness in the models that used all patients (n = 509), autologous HCT in lymphoma (n = 278), and autologous HCT in multiple myeloma (n = 121). Additional studies to evaluate the effect of insurance timeliness on all patients for whom HCT is recommended, not just those who undergo HCT, should be conducted.
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, Nebraska. Electronic address: vijaya.bhatt@unmc.edu.
authors.forename: Vijaya Raj
authors.initials: VR
authors.lastname: Bhatt
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Fausto R
authors.initials: FR
authors.lastname: Loberiza
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Kim
authors.initials: K
authors.lastname: Schmit-Pokorny
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics / Q000401:mortality*; D006801:Humans; D007345:Insurance Claim Review; D007348:Insurance, Health / Q000592:standards*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013534:Survival; D013997:Time Factors; D014481:United States; D055815:Young Adult
keywords: Hematopoietic cell transplantation; Insurance approval; Private insurance; Public payer; Survival; Timeliness