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@ARTICLE{Jansen:167446,
author = {L. Jansen$^*$ and D. Boakye$^*$ and E. Alwers$^*$ and P. R.
Carr$^*$ and C. Reissfelder and M. Schneider and U. M.
Martens and J. Chang-Claude$^*$ and M. Hoffmeister$^*$ and
H. Brenner$^*$},
title = {{U}ptake {R}ates of {N}ovel {T}herapies and {S}urvival
{A}mong {P}rivately {I}nsured {V}ersus {P}ublicly {I}nsured
{P}atients {W}ith {C}olorectal {C}ancer in {G}ermany.},
journal = {Journal of the National Comprehensive Cancer Network},
volume = {19},
number = {4},
issn = {1540-1405},
address = {Cold Spring Harbor, NY},
publisher = {Harborside Press},
reportid = {DKFZ-2021-00350},
pages = {411-420},
year = {2021},
note = {#EA:C070#LA:C070# / 19(4):411-420},
abstract = {In the era of personalized medicine, cancer care is subject
to major changes and innovations. It is unclear, however, to
what extent implementation of such innovations and their
impact on patient outcomes differ by health insurance type.
This study compared provision of treatment and survival
outcomes among patients with colorectal cancer (CRC) who had
statutory health insurance (SHI) versus private health
insurance (PHI) in Germany.We analyzed patterns of CRC
treatment (surgery, chemotherapy/radiotherapy, and targeted
therapy) and survival in a large cohort of patients who were
diagnosed with CRC in 2003 through 2014 and were observed
for an average of 6 years. Associations of type of health
insurance with treatment administration and with overall,
CRC-specific, and recurrence-free survival were investigated
using multivariable logistic and Cox proportional hazards
models, respectively.Of 3,977 patients with CRC, 427
$(11\%)$ had PHI. Although type of health insurance was not
associated with treatment administration in patients with
stage I-III disease, those with stage IV disease with PHI
more often received targeted therapy $(65\%$ vs $40\%;$ odds
ratio, 2.43; $95\%$ CI, 1.20-4.91), with differences
decreasing over time because of catch-up of uptake rates in
patients with SHI. Median overall survival was longer in
patients with PHI than in those with SHI (137.0 vs 114.9
months; P=.010), but survival advantages were explained to a
large extent by differences in sociodemographic factors. In
patients with stage IV disease, survival advantages of PHI
were nonsignificant and were restricted to the early years
after diagnosis.We observed major differences in uptake of
targeted therapy between patients with PHI and those with
SHI but no differences in patient survival after adjusting
for relevant sociodemographic, clinical, and tumor
characteristics. Further studies are needed on factors
associated with the uptake of therapeutic innovations and
their impact on patient survival by health insurance type.},
cin = {C070 / C020 / C120 / HD01},
ddc = {610},
cid = {I:(DE-He78)C070-20160331 / I:(DE-He78)C020-20160331 /
I:(DE-He78)C120-20160331 / I:(DE-He78)HD01-20160331},
pnm = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
pid = {G:(DE-HGF)POF4-313},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:33578373},
doi = {10.6004/jnccn.2020.7636.},
url = {https://inrepo02.dkfz.de/record/167446},
}