All-Cause Mortality and Health Care Resource Utilization in Patients with Type 1 Diabetes Treated with Glucagon-like Peptide 1 Receptor Agonists/Glucose-Dependent Insulinotropic Polypeptide.

Objectives To describe and compare healthcare resource utilization (HRU) among advanced therapy-naïve and advanced therapy-experienced patients with ulcerative colitis (UC) initiating ustekinumab or vedolizumab in the United States. Methods Claims data from IQVIA PharMetrics Plus de-identified database (01/01/2015–06/30/2022) were used to identify adult patients with UC initiating ustekinumab or vedolizumab (index date) after 10/21/2019. Baseline characteristics were balanced using inverse probability of treatment weighting. All-cause and UC-related HRU (number of inpatient admissions, inpatient days, emergency department visits, and outpatient visits) were described during the post-index period, and Poisson regression models were used to evaluate associations between index therapy and HRU outcomes. Analyses were performed separately among advanced therapy-naïve or advanced therapy-experienced patients. Results A total of 444 (ustekinumab) and 1,917 (vedolizumab) advanced therapy-naïve patients, and 647 (ustekinumab) and 1,152 (vedolizumab) advanced therapy-experienced patients were identified. In advanced therapy-naïve patients, higher rates of UC-related inpatient days (rate ratio [95% confidence interval] = 1.84 [1.15, 3.58]; p = 0.004), emergency department visits (1.39 [1.01, 2.17]; p = 0.044), and outpatient visits (1.81 [1.61, 2.04]; p < 0.001) were observed among patients initiating vedolizumab relative to ustekinumab. In advanced therapy-experienced patients, higher rates of UC-related inpatient admissions (1.47 [1.06, 2.12]; p = 0.012), inpatient days (2.18 (1.44, 3.71); p < 0.001), and outpatient visits (1.50 (1.19, 1.82); p < 0.001) were observed among patients initiating vedolizumab relative to ustekinumab. Results were similar when all-cause HRU was examined. Conclusions Among patients with UC with and without advanced therapy experience, higher rates of all-cause and UC-related HRU were observed among those treated with vedolizumab relative to ustekinumab.

New Medications for the Treatment of Diabetes.

BackgroundLong-acting injectable (LAI) antipsychotics, along with community treatment orders (CTOs), are used to improve treatment effectiveness through adherence among individuals with schizophrenia. Understanding real-world medication adherence, and healthcare resource utilization (HRU) and costs in individuals with schizophrenia overall and by CTO status before and after second generation antipsychotic (SGA)-LAI initiation may guide strategies to optimize treatment among those with schizophrenia.MethodsThis retrospective observational single-arm study utilized administrative health data from Alberta, Canada. Adults (≥ 18 years) with schizophrenia who initiated a SGA-LAI (no use in the previous 2-years) between April 1, 2014 and March 31, 2016, and had ≥ 1 additional dispensation of a SGA-LAI were included; index date was the date of SGA-LAI initiation. Medication possession ratio (MPR) was determined, and paired t-tests were used to examine mean differences in all-cause and mental health-related HRU and costs (Canadian dollars), comprised of hospitalizations, physician visits, emergency department visits, and total visits, over the 2-year post-index and 2-year pre-index periods. Analyses were stratified by presence or absence of an active CTO during the pre-index and/or post-index periods.ResultsAmong 1,211 adults with schizophrenia who initiated SGA-LAIs, 64% were males with a mean age of 38 (standard deviation [SD] 14) years. The mean overall antipsychotic MPR was 0.39 (95% confidence interval [CI] 0.36, 0.41) greater during the 2-year post-index period (0.84 [SD 0.26]) compared with the 2-year pre-index period (0.45 [SD 0.40]). All-cause and mental health-related HRU and costs were lower post-index versus pre-index (p < 0.001) for hospitalizations, physician visits, emergency department visits, and total visits; mean total all-cause HRU costs were $33,788 (95% CI -$38,993, -$28,583) lower post- versus pre-index ($40,343 [SD $68,887] versus $74,131 [SD $75,941]), and total mental health-related HRU costs were $34,198 (95%CI -$39,098, -$29,297) lower post- versus pre-index ($34,205 [SD $63,428] versus $68,403 [SD $72,088]) per-patient. Forty-three percent had ≥ 1 active CTO during the study period; HRU and costs varied according to CTO status.ConclusionsSGA-LAIs are associated with greater medication adherence, and lower HRU and costs however the latter vary according to CTO status.

Aims To compare all-cause and Alzheimer’s disease (AD)-related healthcare resource utilization (HCRU) by cognitive stage. Methods and materials This retrospective study analyzed insurance claims data linked to electronic health records (01/01/2015-12/31/2021). Patients with ≥1 cognitive assessment (Mini-Mental State Examination or Montreal Cognitive Assessment) and ≥1 medical or pharmacy claim for an AD diagnosis or AD medications were included. Inverse probability of treatment weighting (IPTW) was used to address potential confounding. All-cause and AD-related HCRU were summarized per patient per year (PPPY) and compared between early AD and advanced AD cohorts (defined according to cognitive scores) using generalized linear regression models; adjusted incidence rate ratios (IRRs), and 95% confidence intervals (CI) were reported. Results A total of 193 patients were included (median age: 82 years; 63.2% female), 108 with early AD and 85 with advanced AD, with similar mean follow up. All-cause HCRU, on average, was similar between early AD and advanced AD cohorts (37.4 PPPY and 38.9 encounters PPPY, respectively). For AD-related HCRU, patients with early AD had fewer encounters PPPY, on average, than patients with advanced AD (1.26 and 3.88 encounters, respectively). Following IPTW adjustment, the advanced AD cohort had significantly higher overall AD-related HCRU (IRR: 3.64 [95% CI: 1.96-6.75], p < 0.001) and outpatient visits (IRR: 2.76 [95% CI: 1.68-4.54], p < 0.001) compared to the early AD cohort. Limitations The relatively small sample size of patients with linked claims and cognitive score data limited the ability to assess contribution of all encounter types to HCRU trends, as well as generalizability to the broader AD population. Conclusions Although all-cause HCRU was similar, patients with advanced AD incurred higher AD-related HCRU compared to patients living with early AD. Further research is needed to determine whether interventions earlier in disease progression can mitigate the AD-related healthcare burden for patients with advanced AD.

Many state Medicaid programs implemented sobriety restrictions that delay timely initiation of direct-acting antivirals (DAAs) for patients with hepatitis C virus (HCV) infections. This claims database study examined the economic impact of sobriety restrictions on DAAs among Medicaid-insured patients with HCV. A retrospective database analysis of the Anlitiks All Payor Claims data (APCD) during the period January 1, 2020 to June 30, 2022 was conducted. Continuously enrolled adult (aged 18-64 years) Medicaid-insured patients with HCV who initiated DAAs (i.e., index date) during the period January 1, 2021 to December 31, 2021 with ≥12 months pre-index and ≥6 months post-index follow-up were categorized into two cohorts (states withsobriety restriction [SR] and states withno sobriety restriction [NSR]) based on the sobriety restriction status in the state ofresidenceon the index date. Measures analyzed were the proportion of patients with one or more all-cause medical healthcare resource utilization (HCRU) (inpatient hospitalization [IP], emergency department [ED], outpatient [OP], professional office [PV], and other [OV] visits) and mean per-patient medical, pharmacy, and overall costs. HCRU and cost differences were compared using adjusted multivariable logistic and gamma-log link regression models, respectively. Patients in the SR (n = 2,295) versus NSR (n = 4,623) cohort had a higher mean age (45 ± 12.02 vs. 43 ± 11.51 years), fewer males (50.28% vs. 58.1%), and they had lower substance use rates (44.10% vs. 59.68%), all significant at p < 0.05. The SR vs. NSR cohort had higher rates of patients with all-cause HCRU by type (IP 22.0% vs.18.1%; ED 42.3% vs. 37.4; OP 62.5% vs. 55.4%; PV 76.4% vs. 69.1%; other visits 47.4% vs. 46.5%). The SR vs. NSR cohort had a significantly higher adjusted odds ratio (95% confidence interval) for IP (2.09; 1.59-2.73) and OP (1.52; 1.28-1.82). Similarly, the SR versus NSR cohort had a significantly higher all-cause adjusted least squares mean cost per patient for IP ($42,616 vs. $15,063), ED ($982 vs. $420), OP ($715 vs. $349), PV ($840 vs. $621), medical ($11,845 vs. $3,850), pharmacy ($53,453 vs. $38,298), and overall ($63,935 vs. $41,524). Patients who initiated DAAs with SR versus NSR had 2 times and 1.5 times greater likelihood of IP and OP visits, respectively. Similarly, the SR versus NSR cohort had 3 times greater medical costs. Restricting DAA access among patients with HCV increases HCRU and cost burden, potentially impeding World Health Organization (WHO) 2030 HCV global elimination goals.

There is a lack of population studies evaluating the impact of bariatric surgery (BRS) on all-cause inpatient mortality. We sought to determine the impact of prior BRS on all-cause mortality and healthcare utilization in hospitalized patients. We analyzed the National Inpatient Sample database from 2007 to 2013. Participants were adult (≥ 18years) inpatients admitted with a diagnosis of morbid obesity or a history of BRS. Propensity score-matched analyses were performed to compare mortality and healthcare resource utilization (hospital length of stay and cost). There were 9,044,103 patient admissions with morbid obesity and 1,066,779 with prior BRS. A propensity score-matched cohort analysis demonstrated that prior BRS was associated with decreased mortality (OR = 0.58; 95% CI [0.54, 0.63]), shorter length of stay (0.59days; P < 0.001), and lower hospital costs ($2152; P < 0.001) compared to morbid obesity. A subgroup of propensity score-matched analysis among patients with high-risk of mortality (leading ten causes of mortality in morbid obesity) revealed a consistently significant reduction in odds of mortality for patients with prior BRS (OR = 0.82; 95% CI [0.72, 0.92]). Hospitalized patients with a history of BRS have lower all-cause mortality and healthcare resource utilization compared to those who are morbidly obese. These observations support the continued application of BRS as an effective and resource-conscious treatment for morbid obesity.

Introduction &amp; Objective: This study aimed to assess the real-world impact of sema OW vs SGLT2i on HbA1c, weight and HCRU outcomes among patients (pts) with T2D in the US. Methods: This observational study of adults with uncontrolled T2D (HbA1c ≥7%) initiating sema OW or SGLT2i (Jan 2018—Feb 2022; first prescription = index) used data from IQVIA PharMetrics® Plus and Ambulatory Electronic Medical Records databases. Changes in HbA1c, weight, BMI and all-cause medical HCRU outcomes after 1 year were compared among inverse probability of treatment weighting (IPTW) adjusted cohorts. Results: Post-IPTW (sema OW: n=416; SGLT2i: n=1093) a significantly higher proportion of pts in the sema OW cohort had combined reductions in HbA1c/weight outcomes vs SGLT2i (Figure). The sema OW cohort had significantly greater mean decreases in HbA1c (-1.6 vs -1.2%, p&amp;lt;0.0001), weight (-4.4 vs -3.4 kg, p&amp;lt;0.0001) and BMI (-1.5 vs -1.1 kg/m2, p=0.013) vs SGLT2i. Over 1-yr follow-up, all-cause HCRU was similar between both cohorts (≥1 hospitalization: 6.0 vs 5.7%, p=0.8190; ≥1 ER visit: 15.2 vs 17.6%, p=0.2658; ≥1 physician office visit: 99.7 vs 99.1%, p=0.2134). Conclusion: Sema OW was associated with greater improvements in HbA1c and weight vs SGLT2i, but with similar HCRU after 1 year. Disclosure J. Amamoo: None. R.P. Doshi: None. J. Noone: Employee; Novo Nordisk. L. Xie: None. C.L. Gamble: Employee; Novo Nordisk. M. Guevarra: Stock/Shareholder; Novo Nordisk. V. Divino: Employee; IQVIA Inc. J. Chen: None. A.A. King: Speaker's Bureau; Abbott, MannKind Corporation, Novo Nordisk. Advisory Panel; Novo Nordisk. Speaker's Bureau; Lilly Diabetes. Advisory Panel; Lilly Diabetes. Speaker's Bureau; Dexcom, Inc. Advisory Panel; Dexcom, Inc. Speaker's Bureau; Astellas Pharma Inc. Funding Novo Nordisk

Health care resource utilization (HCRU) and direct costs incurred over 12 months following initiation of galcanezumab (GMB) or standard-of-care (SOC) preventive migraine treatments have been evaluated. However, a gap in knowledge exists in understanding longer-term HCRU and direct costs. To compare all-cause and migraine-related HCRU and direct costs in patients with migraine initiating GMB or SOC preventive migraine treatments over a 24-month follow-up. This retrospective study used Optum deidentified Market Clarity Data. The study included adults diagnosed with migraine, with at least 1 claim for GMB or SOC preventive migraine therapy (September 2018 to March 2020), with continuous enrollment for 12 months before and 24 months after (follow-up) the index date (date of first GMB or SOC claim). Propensity score (PS) matching (1:1) was used to balance cohorts. All-cause and migraine-related HCRU and direct costs for GMB vs SOC cohorts were reported as mean (SD) per patient per year (PPPY) over a 24-month follow-up and compared using a Z-test. Costs were inflated to 2022 US$. After PS matching, 2,307 patient pairs (mean age: 44.4 years; female sex: 87.3%) were identified. Compared with the SOC cohort, the GMB cohort had lower mean (SD) PPPY all-cause office visits (17.9 [17.7] vs 19.1 [18.7]; P = 0.023) and migraine-related office visits (2.6 [3.3] vs 3.0 [4.7]; P = 0.002) at follow-up. No significant differences were observed between cohorts in other all-cause and migraine-related events assessed including outpatient visits, emergency department (ED) visits, inpatient stays, and other medical visits. The mean (SD) costs PPPY were lower in the GMB cohort compared with the SOC cohort for all-cause office visits ($4,321 [7,518] vs $5,033 [7,211]; P < 0.001) at follow-up. However, the GMB cohort had higher mean (SD) PPPY all-cause total costs ($24,704 [30,705] vs $21,902 [28,213]; P = 0.001) and pharmacy costs ($9,507 [12,659] vs $5,623 [12,605]; P < 0.001) compared with the SOC cohort. Mean (SD) costs PPPY were lower in the GMB cohort for migraine-related office visits ($806 [1,690] vs $1,353 [2,805]; P < 0.001) compared with the SOC cohort. However, the GMB cohort had higher mean (SD) PPPY migraine-related total costs ($8,248 [11,486] vs $5,047 [9,749]; P < 0.001) and migraine-related pharmacy costs ($5,394 [3,986] vs $1,761 [4,133]; P < 0.001) compared with the SOC cohort. There were no significant differences between cohorts in all-cause and migraine-related costs for outpatient visits, ED visits, inpatient stays, and other medical visits. Although total costs were greater for GMB vs SOC following initiation, changes in a few categories of all-cause and migraine-related HCRU and direct costs were lower for GMB over a 24-month follow-up. Additional analysis evaluating indirect health care costs may offer insights into further cost savings incurred with preventive migraine treatment.

New Glucose-Lowering Agents for Diabetic Kidney Disease.

Presentations at the 81st scientific sessions of the American Diabetes Association, part 2.

In patients with type 2 diabetes (T2D), comorbidity-related hospitalizations can have significant impact on longitudinal care. This study aimed to estimate incremental all-cause health care resource utilization (HCRU) and costs between patients with T2D who experienced cardiovascular (CV)-, heart failure (HF)-, or renal-related hospitalizations vs those who did not. This was a retrospective cohort study using data from a large national health plan. Patients with T2D aged 18 to 90 years with CV, HF, or renal hospitalizations were identified from the Humana claims database from October 1, 2009, to September 30, 2015, and separated into CV, HF, and renal cohorts. Patients had 12 months of continuous enrollment prior to the date of first hospitalization (index) and were followed for up to 12 months. Per-patient per-month (PPPM) all-cause HCRU and costs for hospitalized patients were compared with those of no-CV, no-HF, and no-renal cohorts. Differences in baseline characteristics between cohorts were controlled for using generalized linear models. A total of 221,229, 68,126, and 120,105 patients were included in the CV, HF, and renal cohorts, respectively; these patients were older and had higher Deyo-Charlson Comorbidity Index scores than patients in the no-CV, no-HF, and no-renal cohorts. Adjusted for baseline covariates, they had higher mean PPPM inpatient stays, outpatient visits, emergency department visits, and total health care costs. Among patients with T2D, concurrent CV, HF, or renal events present significant disease burden leading to poor quality of life. This information can be used to guide disease management strategies and interventions aimed at reducing comorbidity-related hospitalizations and health care costs, thus providing improved quality of life for these patients.

Introduction: Treatment switching often occurs with biologic use among patients with Crohn’s disease (CD) and has been associated with worsened clinical symptoms and functional impairment. However, little is known about its impact on healthcare resource utilization (HRU) and costs. This study assessed the economic burden associated with treatment switching among adults with CD in the United States (US). Methods: Data from the IBM® MarketScan® Commercial Subset (10/01/2015-03/31/2020) were used to identify adult patients newly diagnosed with CD (at least 2 CD diagnoses at least 30 days apart) and that were treated with a first line biologic (prescription fill/injection) on or after their CD diagnosis. The index date was defined as the date of the first line biologic. Patients were classified into the switchers or non-switchers cohort based on whether or not they switched to another biologic or 5-aminosalicylic acid or immunomodulator during the 12-month study period after the index date. Mean time to treatment switch was estimated using Kaplan-Meier analyses. All-cause HRU and healthcare costs (2020 USD) during the study period were described and compared (unadjusted) overall and for the 2 cohorts. Results: Among 4,006 patients included in the study, 640 were switchers and 3,366 were non-switchers. Overall, mean age was 39.5 years and 50.9% were female. Rates of treatment switch were 7.1% at 6 months and 16.0% at 12 months (Figure). Additionally, rates of prolonged corticosteroid use (at least 90 days) was higher in switchers compared to non-switchers (31.6% vs 8.2%; p< 0.01). Switchers also had higher rates of inpatient admissions (25.9% vs 12.6%; p< 0.01), emergency department visits (41.6% vs 35.4%; p< 0.01), and number of outpatient visits (22.8 vs 17.0; p< 0.01) compared to non-switchers (Table). Similarly to HRU, total all-cause healthcare costs were higher among switchers than non-switchers ($95,689 vs $81,027; p< 0.01), which was mainly driven by higher medical costs ($24,135 vs $14,416; p< 0.01). Among age groups, switchers 30-39 years incurred the highest total cost ($100,676 vs 78,265, p< 0.01). Conclusion: In this real-world study, patients with CD who switched biologic treatments, which is a marker of inadequate treatment, incurred significantly higher HRU and healthcare costs. These findings suggest a potential unmet need with current treatment options and highlight the impact of switching biologics on the economic burden of patients with CD.Figure 1.: Kaplan-Meier analysis for time to switch CI: confidence interval Table 1. - All-cause HRU and healthcare costs incurred during the study period Number of patients, N Switchers (N=640) Non-switchers (N=3,366) All-cause HRU, N (%) Inpatient admission 166 (25.9%) 423 (12.6%) Inpatient days, mean ± SD [median] 2.5 ± 6.4 [0.0] 1.1 ± 4.6 [0.0] Emergency department visits 266 (41.6%) 1,192 (35.4%) Days with outpatient visits 639 (99.8%) 3,331 (99.0%) Number of days with outpatient visits, mean ± SD [median] 22.8 ± 17.0 [19.0] 17.0 ± 16.3 [13.0] Healthcare costs (2020 USD), mean ± SD [median] Total (medical + pharmacy) $95,689 ± $52,295 [$85,713] $81,027 ± $50,743 [$72,464] Medical $24,135 ± $39,519 [$9,434] $14,416 ± $33,575 [$4,847] Inpatient $11,491 ± $31,526 [$0] $5,279 ± $22,861 [$0] Outpatient $10,906 ± $17,172 [$5,956] $7,909 ± $17,732 [$3,687] Emergency department $1,738 ± $4,666 [$0] $1,228 ± $5,330 [$0] Pharmacy (including biologics) $71,554 ± $35,174 [$66,355] $66,611 ± $39,793 [$62,937] HRU: healthcare resource utilization; SD: standard deviation; USD: United States dollar.

PCN108 COMPARISON OF HEALTHCARE RESOURCE UTILIZATION AND COSTS FOR WALDENSTRÖM'S MACROGLOBULINEMIA (WM) PATIENTS TREATED WITH IBRUTINIB OR CHEMOIMMUNOTHERAPY

The high prevalence of chronic diseases, including congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DM), accounts for a large burden of cost and poor health outcomes in US hospitals, and home telehealth (HT) monitoring has been proposed to improve outcomes. To measure the association between HT initiation and 12-month inpatient hospitalizations, emergency department (ED) visits, and mortality in veterans with CHF, COPD, or DM. Comparative effectiveness matched cohort study. Veterans aged 65years and older treated for CHF, COPD, or DM. We matched veterans initiating HT with veterans with similar demographics who did not use HT (1:3). Our outcome measures included a 12-month risk of inpatient hospitalization, ED visits, and all-cause mortality. A total of 139,790 veterans with CHF, 65,966 with COPD, and 192,633 with DM were included in this study. In the year after HT initiation, the risk of hospitalization was not different in those with CHF (adjusted odds ratio [aOR] 1.01, 95% confidence interval [95%CI] 0.98-1.05) or DM (aOR 1.00, 95%CI 0.97-1.03), but it was higher in those with COPD (aOR 1.15, 95%CI 1.09-1.21). The risk of ED visits was higher among HT users with CHF (aOR 1.09, 95%CI 1.05-1.13), COPD (1.24, 95%CI 1.18-1.31), and DM (aOR 1.03, 95%CI 1.00-1.06). All-cause 12-month mortality was lower in those initiating HT monitoring with CHF (aOR 0.70, 95%CI 0.67-0.73) and DM (aOR 0.79, 95%CI 0.75-0.83), but higher in COPD (aOR 1.08, 95%CI 1.00-1.16). The initiation of HT was associated with increased ED visits, no change in hospitalizations, and lower all-cause mortality in patients with CHF or DM, while those with COPD had both higher healthcare utilization and all-cause mortality.

Background: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have demonstrated robust cardiorenal benefits in patients with heart failure with reduced ejection fraction (HFrEF). However, their efficacy and safety in patients with end-stage renal disease (ESRD) requiring dialysis remain underexplored, as these individuals were largely excluded from pivotal clinical trials. Methods: We conducted a retrospective cohort study using deidentified, aggregate data from the TriNetX research network. Adults aged 51-79 years with comorbid HfrEF and ESRD on dialysis were included. Patients were stratified based on SGLT2i use, with all available agents considered. Propensity score matching was applied to balance baseline characteristics. Outcomes were assessed over an 18-month (540-day) follow-up period and included acute decompensated heart failure (ADHF) events, all-cause mortality, hospitalizations, and emergency department (ED) visits. Odds ratios and Cox proportional hazards models were used to compare outcomes between groups. Results: The final cohort included 8,168 patients (n = 4,084 per group; mean age 61 years; 32.5% female; 49.4% White). SGLT2i use was associated with significantly lower rates of all-cause mortality (13.9% vs. 29.2%; risk difference -15.3%, p &lt; 0.001), ADHF events (35.7% vs. 45.1%; risk difference -9.4%, p &lt; 0.001), hospitalizations (47.8% vs. 59.3%; risk difference -11.4%, p &lt; 0.001), and ED visits (37.1% vs. 40.9%; risk difference -3.7%, p &lt; 0.001). Kaplan-Meier analysis demonstrated a statistically significant improvement in survival among SGLT2i users compared to non-users (log-rank p &lt; 0.001). Conclusion: In patients with HFrEF and ESRD on dialysis, SGLT2i therapy was associated with significant reductions in mortality, heart failure exacerbations, and healthcare utilization. These findings support the potential role of SGLT2i in this high-risk population and underscore the need for prospective trials to confirm long-term safety and efficacy.