Effect of Insurance Type on Stage at Presentation, Surgical Approach, Tumor Recurrence and Cancer-Specific Survival in Resectable Non-Small Lung Cancer Patients.

PURPOSE: The aim of this study was to identify the association between Thailand's insurance types and stage at presentation, surgical approach, tumor recurrence and cancer-specific survival in resectable non-small cell lung cancer (NSCLC) patients in northern Thailand. PATIENTS AND METHODS: Medical records of patients with NSCLC who underwent pulmonary resection at Chiang Mai University Hospital from January 2007 through December 2015 were retrospectively reviewed. Patients were divided into two groups: patients with the Universal Coverage Scheme (UCS) or Social Security Scheme (SSS) and patients with the Civil Servant Medical Benefit Scheme (CSMBS) or private insurance (PI). Patient characteristics were assessed. The primary outcome was cancer-specific survival while the secondary outcome was tumor recurrence. Cox's regression and matching propensity score analysis was used to analyze data. RESULTS: This study included 583 patients: 344 with UCS or SSS and 239 with CSMBS or PI. Patients with UCS or SSS were more likely to be active smokers, have a lower percent predicted FEV1, present with higher-stage tumors and worse differentiated tumors, present with tumor necrosis, and undergo an open surgical approach than those with CSMBS or PI. At multivariable analysis of all patients cohort, there were no significant differences in terms of early stage at presentation (adjusted odds ratio (ORadj) = 0.94, 95% confidence interval (CI) = 0.65-1.37), undergoing lobectomy (ORadj = 0.59, 95% CI = 0.24-1.46), and recurrent-free survival (adjusted hazard ratio (HRadj) =1.20, 95% CI = 0.88-1.65) between groups (UCS/SSS versus CSMBS/PI). However, patients with UCS or SSS had shorter cancer-specific survival (HRadj = 1.61, 95% CI = 1.22-2.15). The results from the propensity score matched patient cohort were not different from those analyses on the full patient cohort. CONCLUSION: Thai insurance types have an effect on cancer-specific survival. The Thai government should recognize the importance of these differences, and further multi-center studies with a larger sample size are warranted to confirm this result.

Epidermal Growth Factor Receptor Mutation Testing in Thailand: A Cost-Utility Analysis.

OBJECTIVE: To evaluate the cost utility of epidermal growth factor receptor (EGFR) testing plus first-line gefitinib treatment in patients with activating EGFR mutations in Thailand. METHODS: The study used a decision tree model considering the provider's perspective. Direct medical costs were included and based on a local Thai database. Effectiveness was measured as quality-adjusted life-year and based on randomized controlled trials. Incremental cost-effectiveness ratio was calculated and presented in 2012. A series of one-way sensitivity analyses were conducted. RESULTS: We found that the EGFR testing plus first-line gefitinib alternative gained 0.03 quality-adjusted life-year more, but 62,540 Thailand baht (US $2082.58) less total costs compared with the no-testing alternative. The results were robust when varying most variables in the model except for the duration of gefitinib treatment with activating EGFR mutation, the duration of chemotherapy treatment with activating EGFR mutation, and the utility of second-line chemotherapy. CONCLUSIONS: EGFR testing should be considered before administering EGFR tyrosine-kinase inhibitor such as gefitinib as first-line treatment in patients with non-small cell lung cancer in Thailand where the incidence of EGFR mutation is high.