In a recent publication in Journal of the American Medical Association Network Open, researchers conducted a cross-sectional study to describe state-level variation in the usage of targeted therapies among Medicaid patients with metastatic non-small cell lung cancer (NSCLC) and to define factors correlated with this variation.
This cross-sectional study utilized publicly available data from the 2020 and 2021 Medicaid Drug Utilization Database and peer-reviewed data on NSCLC incidence, the prevalence of epidermal growth factor receptor (EGFR) and anaplastic large-cell lymphoma kinase (ALK) alterations, and expected treatment durations to approximate projected use of targeted therapies for EGFR- and ALK-altered NSCLC in 33 states.
The researchers designated the primary outcome as the estimated percentage of person-time of Medicaid patients with EGFR- or ALK-altered NSCLC correlated with receipt of targeted therapy in each state Medicaid program. The researchers also employed nested linear regression models to assess the relationships between the observed variation and state policies and characteristics.
During 2020 and 2021, 3,461 person-years in which EGFR- or ALK-targeted therapies were indicated; however, only 2,281 person-years of EGFR- or ALK-targeted therapies were dispensed, suggesting that across all states, an estimated 66% of Medicaid patients with EGFR- and ALK-altered metastatic NSCLC received indicated targeted therapies.
The most commonly dispensed agents included osimertinib, alectinib, crizotinib, and lorlatinib. The researchers noted that 83% of targeted therapy prescriptions were for osimertinib and alectinib.
The rates of targeted therapy use differed across the states, with Arkansas (18%) reported as the lowest use and the highest use in Massachusetts (113%). Moreover, the targeted therapy usage rate was generally lower than anticipated in 30 of the 33 states evaluated.
The authors indicated, “The observed variation was associated with Medicaid policies, oncologist density, and state gross domestic product per capita.”
The researchers wrote, “Only three states (9%) had dispensing volumes consistent with expected levels, 12 states (36%) had dispensing volumes somewhat below expected levels, and 18 states (55%) had dispensing volumes substantially below expected levels.”
The researchers also wrote, “Just 66% of person-years in whom targeted therapies were indicated in 2020 and 2021 were associated with the use of those medications, suggesting that at least 500 Medicaid patients with a diagnosis of EGFR- or ALK-altered metastatic NSCLC during these years did not receive targeted therapy when indicated. Given the efficacy of targeted therapies, this underuse could have led to an estimated 855 preventable years of life lost during the analysis period.”
The authors concluded that among Medicaid beneficiaries, they discovered evidence of underutilization of targeted therapies for NSCLC and considerable differences in the use of these efficacious medications across states, limiting access to these therapies. Lastly, the authors concluded that changing Medicaid policies in states could enhance access to these agents and clinical outcomes for patients with NSCLC.
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