Date Of Claim Research Articles

139-LB: Use of Digital Diabetes Solution Is Associated with Improved Glycemic Control without Increased Risk of Severe Hypoglycemia in Adults with Type 2 Diabetes Mellitus in the United States—Retrospective Cohort Study

Background: Dario Diabetes Solution (DDS) is a digital health application (app) that combines blood glucose (BG) monitoring system with a smartphone app, allowing tracking of BG levels in real time. This study assessed effects of DDS on HbA1c levels in adults with type 2 diabetes mellitus (T2DM) with baseline (BL) HbA1c ≥8% and on severe hypoglycemia (SH). Methods: This retrospective cohort analysis included adults with T2DM who used DDS (users) and nonusers from 1JAN2017 to 31OCT2021. BL period was 1 year before index date (users, first DDS registration; nonusers, first claim date in the quarter); follow up was 6 months. DDS users and nonusers were sequentially matched 1:3 using exact and propensity score matching. Secondary endpoints included SH (event requiring medical intervention) rates for all patients (pts) and for pts with BL HbA1c ≥8% who achieved predefined target HbA1c <8%. SH incidence in users vs nonusers was examined. Results: Overall cohort included 568 DDS users and 1699 nonusers: mean age, 57.5±11.3 years; mean BL HbA1c, 9.14±1.83%; oral antidiabetic drugs, 51%; insulin, 6%. BL SH was rare (users, 7/568; nonusers, 12/1699). There were 387 users and 1089 nonusers with BL HbA1c ≥8% (mean BL HbA1c, 10.0±1.7%). In this subgroup, HbA1c <8% was achieved by 9% more DDS users (174/387 [45%]) vs nonusers (393/1089 [36%]) at 6 months; P=0.002. At 6 months, overall SH rate was 38.8 (users) vs 10.6 (nonusers) events/1000 pts per year (incidence rate ratio, 0.9; P=0.9). No observed increase in SH risk was associated with DDS in this population. SH was rare in pts who achieved HbA1c <8% (users, 1/174; nonusers, 3/393). Conclusions: In this retrospective study, a larger proportion of adults with uncontrolled T2DM (BL HbA1c ≥8%) achieved HbA1c <8% after using DDS vs nonusers, with no increased risk of SH. Disclosure N. Thingalaya: None. F. Lee: Employee; Sanofi, Stock/Shareholder; Sanofi. D. Kerr: Consultant; Sanofi-Aventis U. S. P. Potukuchi: None. L. Wilson: Employee; Sanofi. K. C. Lee: Employee; Sanofi. E. K. Han-burgess: Employee; Sanofi. A. Edwards: Employee; Symphony Health, an ICON plc company, Other Relationship; Sanofi. X. Yu: None. A. Kennedy: None. Funding Sanofi

1230-P: Low Real-World Use of SGLT2 Inhibitors in People with Diabetes and Heart Failure—A Population Cohort Study

Background: One of the most striking benefits of sodium-glucose cotransporter 2 inhibitors (SGTL2is) in clinical trials has been the reduction in heart failure (HF) hospitalization. Thus, guidelines recommend SGLT2i use in people with diabetes and HF. Objective: We assessed the real-world dispensation of SGTL2is and the factors associated with their dispensation in people with diabetes and HF. Methods: This retrospective, population-based cohort study identified people with diabetes and HF between Jan 1, 2014 to Dec 31, 2017 in Alberta, Canada (population ~ 4.3 million). Individuals were followed until Dec 31, 2020. The index date was the date of physician or hospitalization claim for HF. The primary exposure was SGTL2i dispensation after HF index date. Demographic and clinical characteristics were summarized, and multivariate logistic regression assessed the factors associated with SGTL2i dispensation adjusting for age, sex, baseline HbA1c, diabetes duration, chronic kidney disease (CKD), atherosclerotic cardiovascular disease (ASCVD), comorbidities (Charlson Comorbidity Index (CCI) score), material deprivation, and urban/rural residence. Results: We identified 22,025 people (43.4% female, mean age 74.7 years ± 11.8 years) with diabetes and HF. Only 10.2% (n=2,247) of individuals with diabetes and HF were dispensed an SGTL2i. Male sex (aOR 1.55; 95% CI 1.39-1.72), age < 65 years (aOR 2.28; 95% CI 2.05-2.54), higher HbA1c (aOR 1.35; 95% 1.31-1.40), no CKD (aOR 3.11; 95% CI 2.78-3.49), ASCVD (aOR 1.48; 95% CI 1.33-1.64), and urban residence (aOR 1.17; 95% CI 1.05-1.31) were associated with SGTL2i dispensation while more co-morbidities were associated with less dispensation (CCI score ≥ 5 aOR 0.36; 95% CI 0.30-0.43). Conclusions: Only 1 in 10 people with diabetes and HF were dispensed an SGTL2i. We identified several factors associated with SGTL2i dispensation and importantly this study highlights a significant opportunity to improve management in people with diabetes and HF. Disclosure S.Butalia: None. C.Wen: None. P.A.Senior: Advisory Panel; Novo Nordisk Canada Inc., Consultant; Novo Nordisk Canada Inc., Bayer Inc., Viatris Inc., Vertex Pharmaceuticals Incorporated, ViaCyte, Inc., Insulet Corporation. R.J.Sigal: Research Support; Novo Nordisk. H.Quan: None. M.Chu: None. P.Kaul: None. Funding Diabetes Canada (OG-3-22-5662-SB)

126-LB: Effect of a Digital Diabetes Solution on All-Cause Health Care Resource Utilization Charges for Patients with Type 2 Diabetes—A Retrospective Cohort Study

Background: Dario Diabetes Solution (DDS) is a digital health application (app) for type 2 diabetes mellitus (T2DM) management that combines a blood glucose (BG) meter and a mobile app, allowing patients (pts) to track BG levels in real time. This study compared all-cause healthcare resource utilization (HCRU; inpatient + ER) and charges for DDS users vs matched nonusers. Methods: This retrospective cohort study (pt selection window: 1JAN2017 - 31APR2021) included adults (≥18 years) with T2DM receiving antidiabetic medication(s) with ≥1 inpatient or ≥2 outpatient visits ≥30 days apart during the baseline (BL) period. BL was 1 year before index date (users, 1st DDS registration; nonusers, 1st claim date in the quarter); follow up was 1 year. User and nonuser cohorts were matched 1:3 using exact and propensity score matching. Study assessed HCRU rates and charges. A 2-part gamma distribution model was used to determine 1) likelihood (odds ratio, OR) of users vs nonusers to incur charges, then 2) total charges per patient per year (PPPY) including all-cause HCRU and office visit (OV) charges. Results: Of 9779 pts, 2445 DDS users and 7334 nonusers were matched; mean age, 58.2±10.6 and 58.3±12.5 years, respectively. At 1 year, users were 9% less likely to incur all-cause HCRU charges vs nonusers (OR, 0.91; P=0.07). All-cause HCRU charges were 26% lower for users vs nonusers (P<0.0001; $12552 [adjusted] PPPY savings). Users were more likely to incur all-cause OV charges vs nonusers (P=0.04). However, users had 19% lower all-cause OV charges vs nonusers (P<0.0001; $1790 [adjusted] PPPY savings). The percentages of pts who incurred T2DM related HCRU charges were low (users, 3.1%; nonusers, 3.0%). Conclusions: In this retrospective cohort study, pts with T2DM who utilized DDS incurred significantly lower all-cause HCRU and OV charges vs nonusers. Disclosure L. Wilson: Employee; Sanofi. D. C. Malone: Consultant; Sanofi Genzyme, Avidity, Sarepta, Pear Therapeutics, Gilead Sciences, Inc., Novartis. P. Potukuchi: None. N. Thingalaya: None. K. C. Lee: Employee; Sanofi. A. Edwards: Other Relationship; Sanofi. Employee; Symphony Health, an ICON plc company. X. Yu: None. F. Lee: Employee; Sanofi. Stock/Shareholder; Sanofi. A. Kennedy: None. E. K. Han-Burgess: Employee; Sanofi. D. Brixner: Consultant; Sanofi. Funding Sanofi

Healthcare utilization and direct medical costs of Huntington’s disease among Medicaid beneficiaries in the United States

AimsTo provide more recent estimates of healthcare utilization and costs in Huntington’s disease (HD) in the Medicaid population.Materials and MethodsThis retrospective analysis used administrative claims data for HD beneficiaries (≥1 HD claim; ICD-9-CM 333.4) from Medicaid Analytic eXtract data files from 1 January 2010–31 December 2014. The date of the first HD claim during the identification period (1 January 2011–31 December 2013) was assigned as the index date. If a beneficiary had multiple HD claims during the identification period, one was randomly chosen as the index date. Beneficiaries were required to be continuously enrolled in fee-for-service plans during the 1-year pre-index and post-index periods. Medicaid beneficiaries without HD were drawn from a 100% random sample and matched (3:1) to those with HD. Beneficiaries were classified by disease stage (early/middle/late). All-cause and HD-related (any utilization related to HD diagnosis or symptoms associated with HD) healthcare utilization and costs were reported.ResultsA total of 1,785 beneficiaries without HD were matched to 595 beneficiaries with HD (139 early-, 78 middle-, and 378 late-stage). The mean (SD) annual total costs were higher for beneficiaries with HD than beneficiaries without HD ($73,087 [$75,140] vs. $26,834 [$47,659], p <.001) and driven by inpatient costs ($45,190 [$48,185] vs. $13,808 [$39,596], p <.001). Total healthcare costs were highest among beneficiaries with late-stage HD (mean [SD] cost: $22,797 [$31,683] for early-stage HD vs. $55,294 [$129,290] for middle-stage HD vs. $95,251 [$60,197] for late-stage HD; p <.001).LimitationsAdministrative claims are intended for billing purposes and subject to coding errors. This study did not address functional status, which may provide further insight to late-stage and end-of-life burden of HD, and indirect costs.ConclusionsMedicaid beneficiaries with HD have higher acute healthcare utilization and costs compared to beneficiaries without HD, which tend to increase with disease progression, indicating that HD beneficiaries at later disease stages have greater burden.

Real-world analysis of commercially insured and Medicare Advantage patients with advanced cancer and rates of molecular testing.

6633 Background: Guideline-recommended molecular testing has become essential for biomarker-guided clinical decision making, particularly for patients with advanced (adv) disease. Several biomarkers have indications that are tumor type-agnostic (starting with MSI in 2017, NTRK in 2018, TMB in 2020, and RET and BRAF in 2022). Biomarker testing is covered by insurers, both Medicare (covers comprehensive genomic profiling [CGP] and non-CGP panels) and commercial (at least non-CGP). This study aimed to understand utilization of biomarker testing across tumor types. Methods: This retrospective analysis used de-identified administrative claims from Optum Labs Data Warehouse. Adult Commercial (COM) and Medicare Advantage (MA) enrollees diagnosed with any 1 of 6 adv cancer types from 1/2018 to 8/2021 were identified; the date of the first claim indicating adv cancer was the index date. Continuous enrollment for 12 months prior to (baseline), and ≥6 months post-index date, unless they died (follow-up) was required. Biomarker testing was captured using Current Procedural Terminology (CPT) codes indicating CGP (&gt; 50 gene panels), non-CGP (at most 5-50 gene panels), or CPT code 81479 (unlisted molecular pathology procedure) during the study period. The primary analysis evaluates testing in the follow-up only, with secondary analyses evaluating testing including the baseline (to account for testing prior to the index date). Results: We identified 16,931 breast (BC), 16,838 non-small cell lung (NSCLC), 8,755 colorectal (CRC), 4,244 pancreatic (PC), 2,610 ovarian (OC), and 1,231 gastric (GC) adv cancer patients meeting study criteria. Overall biomarker testing rates in the follow-up period were: 37% NSCLC, 19% BC, 41% CRC, 35% PC, 51% OC, 35% GC. The Table shows testing rates by cancer, insurance type, and panel size during follow-up. Testing rates were lower among MA patients compared to COM patients. Even considering baseline and follow-up periods, overall biomarker testing rates were low, and lower among MA compared to COM : 48% NSCLC (53% COM, 47% MA), 27% BC (34% COM, 22% BC), 56% OC (61% COM, 53% MA),42% PC (53% COM, 38% MA), 47% CRC (56% COM, 42% MA), 41% GC (54% COM, 35% MA). Conclusions: Considering guideline recommendations, rates of biomarker testing across tumor types are far from optimal despite insurance coverage for testing. Identification of barriers to biomarker testing and interventions to overcome these are needed to improve adherence to biomarker testing guidelines. [Table: see text]

0387 Burden of insomnia among Alzheimer's patients: variations in comorbidities and healthcare utilization in Medicaid enrollees

Abstract Introduction Sleep disturbance contributes to the burden of Alzheimer’s disease (AD), specifically among vulnerable patients with behavioral symptoms and multiple comorbidities. Limited information exists regarding the characteristics associated with insomnia among patients with AD. This study describes medical conditions and healthcare utilization among patients with AD and insomnia. Methods This retrospective cohort study used MarketScan® Multi-State Medicaid Database 2016-2020 and included adults aged ≥ 50 with newly diagnosed AD. Index date was the earliest medical or pharmacy claim date for insomnia within 3 months prior to 12 months post AD date. For comparison, non-insomnia cohort was selected based on propensity score 1:1 matching. Comorbid conditions and behavioral symptoms (BS) - including agitation aggression, psychotic symptoms, and mood disorders – and delirium were measured in the 12-month baseline period and were compared across insomnia and non-insomnia cohorts using chi-square tests. Healthcare utilization was assessed in 12-month post-index date (follow-up period). Results Among patients with incident AD, significantly higher proportions of individuals with comorbidities were detected in insomnia (N=3,904) vs. non-insomnia (N=3,904) cohorts in 12-month baseline period, i.e., hypertension (76.2% vs. 71.2%, p &amp;lt; 0.001), diabetes (35% vs. 32.9%, p=0.05), valvular disease (11.6% vs. 9.8%, p=0.01), delirium (5.1% vs. 3.7%, p=0.002) and BS (62.4% vs. 46%, p&amp;lt; 0.0001). The proportion of patients with BS during follow-up was higher in the insomnia cohort (76.18%) in comparison to the non-insomnia cohort (53.53%). In the follow-up, proportion of inpatient, emergency room and physician office visits were 34.5%, 49.8%, 45.6% in insomnia and 30.7%, 42.5%, 41.2% in non-insomnia cohorts respectively. Mean (SD) inpatient length-of-stay was 3.2 (9.62) days for insomnia and 2.6 (8.52) days for non-insomnia cohorts respectively. Conclusion The study results indicate that major comorbidities and behavioral symptoms are highly prevalent among insomnia patients with AD. Insomnia is associated with higher utilization rates when healthcare use is compared between insomnia and non-insomnia patients. Optimization of insomnia treatment is crucial for the disease management in AD patients. Support (if any) Funding for this research was provided by Merck Sharp &amp; Dohme Corp., a subsidiary of Merck &amp; Co., Inc., Rahway, NJ, USA.

What Comes First: The Diagnosis or the Pill? Evidence from Alzheimer’s Disease Population (P2-6.003)

<h3>Objective:</h3> To investigate frequency of and characteristics associated with Alzheimer’s Disease (AD) treatment initiation before receiving an AD diagnosis. <h3>Background:</h3> AD is a neurodegenerative disorder with a potentially lengthy and challenging diagnosis process. Receiving an AD diagnosis may lead to certain restrictions and reporting requirements for patients and families. Hence, physicians may initiate cholinesterase inhibitors as a first-line treatment to slow progression prior to recording an AD diagnosis. <h3>Design/Methods:</h3> Commercial and Medicare Advantage Prescription Drug enrollees in the Optum’s de-identified Clinformatics® Data Mart Database with ≥2 pharmacy or medical claims for brand or generic donepezil or rivastigmine during 01 January 2019 – 31 December 2021 (date of first claim=index date), age ≥18, continuous enrollment 6 months prior to (baseline) and at least 12 months following (follow-up) index date, and no claims for either medication in baseline were included. Patients were stratified into AD-diagnosis vs. no-AD diagnosis cohorts based on having ≥1 AD diagnosis in baseline or at index. Patient age, sex, race/ethnicity, dementia-related conditions, and time to AD diagnosis were evaluated. <h3>Results:</h3> Among 299,018 patients with ≥1 claim for donepezil or rivastigmine, 58,997 met full selection criteria. The study population had mean age of 78.3 (SD: 7.47) years, were majority female (60.8%), and were approximately 68% Caucasian. Commonly diagnosed dementia-related conditions in baseline or at index were mild cognitive impairment (50.0%), general/unspecified dementia (47.9%), and vascular dementia (7.1%). Among treatment initiators only 21.1%% patients had an AD diagnosis compared with 78.9% without an AD diagnosis in baseline or at index. Mean time to AD diagnosis from treatment initiation was 12.1 (median: 7.9) months. <h3>Conclusions:</h3> These results highlight that most AD patients are initiated on treatment ahead of diagnosis. These findings are especially important considering new AD therapeutics that would likely have stringent prior authorization criteria linked to an existing AD diagnosis. <b>Disclosure:</b> Helen Trenz has nothing to disclose. Dr. Glenn has nothing to disclose. Michael Johnson has nothing to disclose. Jeffrey McPheeters has nothing to disclose.

Real-world Adherence to Subsequent Prophylactic Therapy Among Chronic Migraine (CM) Patients Initially Treated With a Calcitonin Gene–related Peptide Monoclonal Antibody (CGRP mAb) (P6-12.009)

<h3>Objective:</h3> To examine adherence to branded preventive chronic migraine (CM) treatments among patients who initiated calcitonin gene–related peptide monoclonal antibody (CGRP mAb) treatment and subsequently added on or switched to another branded preventive treatment. <h3>Background:</h3> OnabotulinumtoxinA (OnabotA) and CGRP mAbs treat CM prophylactically. CM patients treated with a CGRP mAb may introduce a subsequent treatment, but little is known about adherence to the subsequent CM treatment. <h3>Design/Methods:</h3> This retrospective cohort study included adult CM patients (ICD-10-CM G43.7XX) treated with a CGRP mAb and a subsequent CM treatment from IBM MarketScan® claims databases (05/17/2018 – 06/30/2021). The index date was the first claim date of subsequent treatment. Patients were categorized into three cohorts: switch to another CGRP mAb, switch to OnabotA, and add-on OnabotA (concomitant with CGRP mAb ≥28 days immediately following index). Baseline characteristics were assessed during the 6-month pre-index period. Adherence was defined as ≥80% of days covered on index treatment over the 6-month follow-up period. Difference in adherence between cohorts was compared using a Chi-square test and adjusted for baseline characteristics using logistic regression. <h3>Results:</h3> A total of 1315 patients were included; 745 switched to a CGRP mAb, 449 switched to OnabotA, and 121 added OnabotA. Mean age was 41.9, 39.8, and 41.3 years, respectively, and all cohorts were ≥86% female. Adherence was highest for add-on OnabotA, followed by switch to OnabotA, and, lastly, switch to CGRP mAb (68.6% vs 61.5% vs 33.2%, respectively; <i>P</i>&lt;0.0001). After adjustment, switch to OnabotA and add-on OnabotA cohorts had 3.3 (95% CI: 2.5–4.2) and 4.6 (95% CI: 3.0–7.0) times higher odds of adherence compared with the switch to CGRP mAb cohort. <h3>Conclusions:</h3> Following a CGRP mAb, adding on or switching to OnabotA as a subsequent CM treatment was associated with significantly higher adherence over 6 months compared with switching to another CGRP mAb. <b>Disclosure:</b> Ms. Gusovsky has nothing to disclose. Ms. DONG has received personal compensation for serving as an employee of AbbVie. Ms. DONG has stock in AbbVie. Ms. DONG has received research support from National Institutes of Health. Changgeng Zhao has received personal compensation for serving as an employee of AbbVie. Changgeng Zhao has stock in AbbVie. Mr. Park has received personal compensation for serving as an employee of AbbVie. Mr. Park has stock in AbbVie. Ms. Shah has received personal compensation for serving as an employee of AbbVie. Ms. Shah has stock in AbbVie Inc. An immediate family member of Ms. Shah has received research support from National Institutes of Health.

Prolonged oral corticosteroid treatment in patients with systemic lupus erythematosus: An evaluation of 12-month economic and clinical burden.

BACKGROUND: Prolonged, high-dose corticosteroid treatment for systemic lupus erythematosus (SLE) is associated with substantial health care costs, health care resource utilization (HCRU), and adverse events (AEs). OBJECTIVE: To compare all-cause health care costs, HCRU, and oral corticosteroid (OCS)-related AEs among patients with prevalent OCS use and patients without OCS use. METHODS: This retrospective, longitudinal cohort study (GSK study 214100) used claims data from the IQVIA Real-World Data Adjudicated Claims - US, IQVIA, Inc, database between January 1, 2006, and July 31, 2019, to identify patients with SLE. Patients with at least 1 OCS pharmacy claim during the study period and continuous OCS use during the 6-month pre-index (baseline) period (index date is the date of the first OCS claim following 6 months' continuous use) formed the "prevalent OCS use cohort." This cohort was subdivided based on the level of OCS exposure during the 12-month observation period, ie, the number of 6-month periods of greater than 5 mg/day OCS use (0, 1, or 2). Patients without OCS claims formed the "no OCS use cohort." All patients had continuous enrollment during the baseline and observation periods, had at least 1 inpatient or at least 2 outpatient SLE diagnosis codes during baseline, and were aged at least 5 years at index. A 2-part model, a generalized linear regression model with a negative binomial distribution, and a multivariate logistic regression model were used to compare health care costs, HCRU, and the odds of developing an OCS-related AE between cohorts, respectively. RESULTS: The no OCS use and prevalent OCS use cohorts included 21,517 and 16,209 patients, respectively. Adjusted health care cost differences (95% CI) were significantly lower for the no OCS use cohort vs all prevalent OCS use exposure categories ($5,439 [$4,537-$6,371] vs $17,856 [$16,368-$19,498]), driven by inpatient stays and outpatient visits; HCRU was also significantly lower (adjusted incidence rate ratios vs no OCS use cohort [95% CI]: 1.20 [1.16-1.23] vs 1.47 [1.41-1.52]). Health care costs and HCRU increased with increasing length of OCS exposure. OCS-related AEs occurred more frequently for all prevalent OCS use exposure categories vs the no OCS use cohort (odds ratio [95% CI]: 1.39 [1.25-1.55] vs 2.32 [2.02-2.68]), driven by hematologic/oncologic and immune system-related AEs. The mean (SD) average daily dose of OCS increased with increasing periods of prevalent OCS use (2.5 [1.3], 6.9 [31.1], and 34.6 [1,717.3] mg/day, respectively, for patients with 0, 1, and 2 periods of OCS use). CONCLUSIONS: Prevalent OCS use incurs a substantial clinical and economic burden, highlighting the need for restricted OCS doses and durations. DISCLOSURES: This study (GSK Study 214100) was funded by GSK. GSK was involved in designing the study, contributing to the collection, analysis, and interpretation of the data, supporting the authors in the development of the manuscript, and funding the medical writing assistance. All authors, including those employed by GSK, approved the content of the submitted manuscript and were involved in the decision to submit the manuscript for publication. Dr DerSarkissian, Dr Duh, and Mr Benson are employees of Analysis Group, which received research funding from GSK to conduct this study. Dr Wang, Ms Gu, and Mr Vu are former employees of Analysis Group. Mr Bell is an employee of GSK and holds stocks and shares in the company. Ms Averell and Dr Huang are former employees of GSK and held stocks and shares in the company at the time of the study.

Real-World Treatment Patterns and Healthcare Resource Utilization in Patients Prescribed Benztropine: A Claims Analysis From 2017-2020

AbstractIntroductionWe sought to examine real-world treatment patterns and healthcare resource utilization (HCRU) for patients receiving an antipsychotic (AP) and subsequently prescribed benztropine.MethodsA retrospective analysis was conducted among patients with evidence of benztropine initiation using claims data from IQVIA’s New Data Warehouse from January 2017–March 2020. Patients were indexed on the date of first pharmacy claim for benztropine and had continuous enrollment in the 6 months prior (pre-index) and minimum 12 months post-index date, up to 24 months. Patients also had ≥1 pharmacy claim for an AP either pre-index or on the index date.ResultsA total of 112,542 patients were included; 59% were female with mean age of 46 years. The most common comorbidities were bipolar disorder (BD; 28.3%), schizophrenia (SCZ; 28.3%), and depression (26.3%). Over half of the cohort (54.1%) had ≥2 comorbid conditions. Nearly 20% of patients had ≥20 medications (median 10–14) and medications with anticholinergic (AC) properties were used by 87.9%. Approximately 80% of patients had mild AC burden at baseline (using AC burden calculator). The median number of benztropine prescription fills was 5 with treatment duration &lt;3 months in 44.3% of patients and &lt;6 months in 61.7%. All-cause mean healthcare costs in the 12-month cohort (24-month cohort) were $11,755 ($23,128), mean costs for pharmacy were $9,229 ($18,148), and mean costs for inpatient stays were $34,669 ($41,280). Emergency room (ER) visits occurred in 47.3% and physician office visits in 78.9% of the cohort. In patients with available inpatient 12-month data (n=33,717), inpatient stays occurred in 4.0% (13.3% when extrapolated to total cohort). In patients with 24-month data (n=73,836), ER visits occurred in 61% of the cohort and inpatient stays in 6.6% (21.9% when extrapolated to the total cohort). Multivariate analyses showed baseline SCZ was associated with a significantly increased risk of ER visit of 30% and inpatient stay of 50%. Similarly, substance abuse was associated with an increased risk of ER visit of 85% and inpatient stay of about 40%. Other significant associations with ER visits included falls/accidents at baseline (148% increased risk), abnormal movement disorders (38% increased risk), and orthostatic hypotension (38% increased risk).ConclusionsIn this real-world analysis of patients initiating benztropine, polypharmacy and AC burden were frequently observed. BD, SCZ, and depression were the most common comorbidities. Healthcare costs and HCRU were high for the entire cohort; inpatient stays contributed to high costs. Baseline SCZ, falls/accidents (ER only), and substance abuse were significantly associated with ER and inpatient admissions. The comorbidity and medication profiles of this cohort may have influenced the high healthcare costs and HCRU observed in the study.FundingNeurocrine Biosciences, Inc.

Real-world characteristics of patients with sickle cell disease who initiated crizanlizumab therapy

Objective To provide real-word evidence of patients with SCD initiating crizanlizumab, their use of other SCD treatments, and crizanlizumab treatment patterns. Methods Using IQVIA’s US-based, Longitudinal Patient-Centric Pharmacy and Medical Claims Databases patients with a diagnosis of SCD between November 1, 2018, and April 30, 2021, and ≥1 claim for crizanlizumab (date of first claim = index date) between November 1, 2019, and January 31, 2021 who were ≥16 years of age, and had ≥12 months of pre-index data were selected for analysis. Two cohorts were identified based on available follow-up time (3- and 6-month cohorts). Patient characteristics were reported along with pre- and post-index SCD treatments and crizanlizumab treatment patterns (e.g. total doses received, gap-days between doses, days on therapy, discontinuation, and restarts). Results 540 patients met the base inclusion criteria (345 in the 3-month cohort and 262 in the 6-month cohort. Most patients (64%) were female with a mean (SD) age of 35 (12) years overall. Concomitant hydroxyurea use was observed in 19–39% of patients, while concomitant L-glutamine use was observed for 4–8% of patients. 85% of 3-month cohort patients received at least two doses of crizanlizumab, while 66% of the 6-month cohort received at least 4 doses of crizanlizumab. The median number of gap days between doses was 1 or 2. Conclusions 66% of patients who receive crizanlizumab receive at least 4 doses within 6-months. The low median number of gap days suggests high adherence.

Hidden Otolaryngology Malpractice Claims: An Internal Review From 2000 to 2020.

To report key characteristics and patterns of captive insurance claims not publicly reported in otolaryngology across a large tertiary-level academic health system over the previous 2 decades. Case series. The tertiary care health system. The internal captive insurance database at a tertiary level healthcare system was queried to identify otolaryngology-related malpractice claims regardless of final disposition (settled or dismissed) filed from 2000 to 2020. The date of the incident, date of claim, error type, patient outcome, provider subspecialty, total expenses, disposition, and final reward amount were recorded. Twenty-eight claims were identified. There were 11 (39.3%) claims from 2000 to 2010 and 17 (60.7%) claims from 2011 to 2020. Head and neck surgery was the most frequently implicated subspecialty (n = 9, 32.1% of all cases), followed by general otolaryngology (n = 7, 25.0%), pediatrics (n = 5, 17.9%), skull base/rhinology (n = 4, 14.3%), and laryngology (n = 1, 3.6%). Improper surgical performance was cited in 35.7% of cases (n = 10), followed by failure to diagnose (n = 8, 28.6%), to treat (n = 4, 14.3%), and to obtain informed consent (n = 3, 10.7%). While 2 cases are ongoing, a total of 17/26 (65.4%) cases were settled and 20/26 (76.9%) dismissed some or all parties. Dismissed claims had significantly higher expenses (p = .022) and duration from incident to disposition (p = .013) compared to settled claims. This study expands the malpractice landscape in otolaryngology by including data not readily available through public sources and compares it to national trends. These findings encourage otolaryngologists to better gauge current quality and safety measures that best protect patients from harm.

P547 Rate of Colectomy Increases within Twelve Months of Sequential Therapy for Ulcerative Colitis

Abstract Background Even the best medical treatments for ulcerative colitis (UC) are often ineffective, with up to 15% of patients requiring a colectomy within the first 10 years of diagnosis. In the current era, patients have access to an increasing number of medical therapies that may prevent and/or delay surgery. To evaluate the relative effectiveness of sequential therapies for UC, we evaluated the 12-month colectomy rate among patients switching to a second, third, or fourth-line biologic or small molecule therapy for UC. Methods We conducted a retrospective cohort study, using a new-user design, evaluating patients with commercial insurance in the MarketScan database between 2000 and 2019. The index date for the study was defined as the date of the first claim for a second, third, or fourth biologic or small molecule therapy. The primary outcome was defined as colectomy-free survival at 12 months after the index date. Significance of 12-month colectomy rates over time was evaluated using the Cochran-Armitage test of trend and a Generalized Estimating Equation (GEE) model adjusting for age (18-35, 36-55, &amp;gt;55), sex and index year (year 2007-2014 and 2015-2019). Results We identified 3,325 patients with UC that made at least 1 switch in biologic or small molecule therapy during the study period. Among these, 50% were female and the median age was 41 years (interquartile range 31-52 years, Table 1). The most frequent initial biologic switches were from an anti-tumor necrosis factor alpha (TNF) to an anti-TNF (1895 patients [57%]) and anti-TNF to vedolizumab (980 patients [30%]) were the most common sequences of therapies (Table 2). Overall, 392 (12%) patients underwent colectomy within 12 months of the first switch while 116 of 695 (17%) patients underwent colectomy within 12 months of the second switch. Among 161 patients that underwent 3 switches, 30 (19%) underwent colectomy within 12 months of the third switch (p&amp;lt;0.001, Table 3). The rate of UC-related hospitalizations in the 12 months after switch also increased significantly with each subsequent switch (11% vs. 15% vs. 19% for first, second and third switches respectively, p&amp;lt;0.001). The colectomy rate per switch in therapy appeared stable when stratifying by index date and age at index date (Figure 1). Conclusion Despite increases in the number of available mechanisms for the treatment of UC, a substantial proportion of patients will still require colectomy for UC. The absolute risk of colectomy within 12 months and other negative outcomes increase with each subsequent treatment. These data can help inform complex decisions regarding the timing of surgery relative to initiation of subsequent therapy in patients with medically-refractory disease.

Increased Risk of Venous Thromboembolism in Patients With Amyotrophic Lateral Sclerosis: Results From a US Insurance Claims Database Study.

Reduced mobility in patients with amyotrophic lateral sclerosis (ALS) is hypothesized to increase the risk of venous thromboembolism (VTE). A few small, single-center studies have investigated the risk of VTE in patients with ALS. Given the high morbidity and mortality associated with VTE, further understanding of the risk in patients with ALS may inform clinical care. The objective of this study was to investigate the incidence of VTE in patients with ALS compared with controls without ALS. Patients were identified from a US health insurance claims database, Optum's deidentified Clinformatics Data Mart Database, between 2004 and 2019. ALS cases were defined as patients aged 18 years or older with (1) 2 or more ALS claims at least 27 days apart including at least 1 claim from a neurologist visit or (2) 1 or more ALS claims and a prescription for riluzole or edaravone. Each ALS case was matched on age and sex to 5 controls without ALS. VTE was defined as at least 1 claim for VTE and at least 1 anticoagulant prescription or VTE-related procedure within 7 days before and 30 days after a VTE claim date. Incidence rates were reported per 1,000 person-years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards model. Among 4,205 ALS cases and 21,025 controls, incident VTE occurred in 132 ALS cases (3.1%) and 244 controls (1.2%). Incidence rates of VTE were 19.9 per 1,000 person-years (95% CI 16.7-23.6) in ALS cases compared with 6.0 per 1,000 person-years (95% CI 5.0-7.1) in controls. ALS cases were about 3 times more likely to develop VTE (HR 3.3, 95% CI 2.6-4.0), with similar results among men and women. The median time to first VTE was 10 months from the initial ALS claim in ALS cases. Consistent with previous smaller studies, a higher incidence rate of VTE was observed in a large sample of patients with ALS from across the United States, as compared to matched controls. The markedly increased risk underscores the importance of preventive efforts and careful monitoring for VTE in patients with ALS and may have implications for the management of ALS.

Characteristics of initiators of budesonide/glycopyrrolate/formoterol for treatment of chronic obstructive pulmonary disease (COPD) in the United States: the AURA study.

A twice-daily single inhaler triple therapy consisting of budesonide/glycopyrrolate/formoterol fumarate (BGF) was approved by the US Food and Drug Administration (FDA) in July 2020 as a maintenance treatment for patients with chronic obstructive pulmonary disease (COPD). The objective of this AURA study is to describe patient characteristics, exacerbation and treatment history, and healthcare resource utilization (HCRU) before BGF initiation to better inform treatment decisions for prescribers. This retrospective cohort study leveraged data of all payer types from IQVIA's Longitudinal Prescription Data (LRx) linked to Medical Data (Dx). Patients with COPD who had ⩾1 LRx claim for BGF between 1 October 2020 and 30 September 2021 were included. The date of first BGF claim was the index date. Patient demographic and clinical characteristics, history of COPD exacerbation or related event, treatment history, and HCRU were assessed during the 12 months before index (baseline). We identified 30,339 patients with COPD initiating BGF (mean age: 68.2 years; 57.1% female; 67.6% Medicare). Unspecified COPD (J44.9; 74.0%) was the most commonly coded COPD phenotype. The most prevalent respiratory conditions/symptoms were dyspnea (50.8%), lower respiratory tract infection (25.3%), and sleep apnea (19.0%). Uncomplicated hypertension (58.8%), dyslipidemia (43.9%), cardiovascular disease (41.4%), and heart failure (19.9%) were the most prevalent nonrespiratory conditions. During the 12-month baseline, 57.9% of patients had evidence of a COPD exacerbation or related event, and 14.9% had ⩾1 COPD-related emergency department (ED) visit; 21.0% of patients had evidence of prior triple therapy use, while 54.3% had ⩾1 oral corticosteroid (OCS) fill. Among OCS users, 29.9% had cumulative exposures >1000 mg [median [Q1-Q3] exposure: 520 (260-1183) mg]. This real-world data analysis indicates that BGF is being initiated in patients with COPD experiencing symptoms and exacerbations despite current therapy, and among patients who have various chronic comorbidities, most often cardiopulmonary-related.

1255. Single-tablet Regimens (STR) Offer Better Persistence and Adherence, with Lower Costs by Adherence Status, than Multiple-tablet Regimens (MTR) for People Living with HIV (PLWH) Enrolled in Medicaid

Abstract Background Pill burden associated with antiretroviral multiple-tablet regimens (MTR) can impact adherence. The shift to single-tablet regimens (STR) has lagged for people living with HIV (PLWH) covered by Medicaid. This study examines persistence, adherence, healthcare resource utilization (HCRU), and costs by STR or MTR use for new initiators and treatment-experienced PLWH over a 1-year study period. Methods A linked patient population was applied using data from IQVIA’s Prescription Claims (Rx), Professional Fee Claims (Dx), and Hospital Charge Data Master (CDM). A 6-month pre-index period was used to assess study eligibility and baseline characteristics. A 12-month post-index period was used to descriptively evaluate treatment patterns and HCRU/costs. Two mutually exclusive cohorts were created based on STR or MTR use during the selection window (01/2018-07/2019). For the STR cohort, date of the first STR claim during the selection window was termed the index date. For the MTR cohort, the date of the first MTR drug during the selection window was termed the index date. Results The final sample comprised 4,603 PLWH in the STR cohort and 2,728 in the MTR cohort (Table 1). The proportion persistent over the 1-year follow-up was higher among treatment experienced compared to new initiators, and higher for STR compared to MTR (Figure 1A). The proportion adherent was higher among treatment experienced compared to new initiators, and higher for STR compared to MTR (Figure 1B). HIV-specific per member per month (PMPM) pharmacy costs were higher among treatment experienced compared to new initiators, and higher for MTR compared to STR (Figure 2). Adherent PLWH had a lower proportion with ≥ 1 all-cause emergency room visit compared to non-adherent PLWH within a cohort/treatment status category; minimal differences in ≥ 1 all-cause hospitalization. Adherent PLWH had higher mean all-cause costs than non-adherent PLWH, driven by pharmacy costs. STR PLWH had lower mean all-cause total costs compared to MTR PLWH with the same adherence/treatment experience status (Figure 3). Conclusion PLWH enrolled in Medicaid are more persistent and adherent to STR than MTR. Among PLWH adherent to antiretroviral therapy, STR offer potential cost savings over MTR for appropriate patients. Disclosures Andrew P. Brogan, PhD, ViiV Healthcare: Employee, Salary|ViiV Healthcare: Stocks/Bonds Cindy Garris, MS, ViiV Healthcare: Employee|ViiV Healthcare: Stocks/Bonds Julie Priest, MSPH, ViiV Healthcare: Employee, Salary|ViiV Healthcare: Stocks/Bonds Victoria Divino, BA, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support Jing He, PhD, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support Justin Chen, MHS, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support Mitch DeKoven, MHSA, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support.

1254. An Increase in Single-tablet Regimen (STR) Utilization for People Living with HIV (PLWH) Enrolled in Medicaid had Minimal Impact on Pharmacy Costs

Abstract Background The shift to antiretroviral single-tablet regimens (STR) from multiple-tablet regimens (MTR) has lagged for people living with HIV (PLWH) covered by Medicaid. This study examines STR and MTR utilization and pharmacy costs over a 5-year period for PLWH enrolled in Medicaid. Methods This retrospective study used IQVIA’s Prescription Claims (Rx) data to identify two mutually exclusive cohorts based on STR or MTR use within each of 5 calendar years (2016-2020). For the STR cohort, the date of the first STR claim in each calendar year was termed the index date. For the MTR cohort, the date of the first MTR drug in the first observed complete MTR regimen in each calendar year was termed the index date; a window of 5 days between prescription fills for the agents used in an MTR regimen was allowed. The regimen received on the index date was used to assign the study cohort for each year and study measures were reported for each of the 5 calendar years. Additional eligibility criteria are provided in Table 1. Results The final STR cohort was 47,140 (14.5% of the initial sample) in 2016 and 73,111 (13.5%) in 2020 (Table 1). The final MTR cohort was 36,007 (15.5%) in 2016 and 20,264 (13.5%) in 2020. The distribution of PLWH with Medicaid Fee-For-Service (FFS) or Medicaid managed care was generally similar by year for both STR and MTR cohorts from 2016 to 2019 (Figure 1); Medicaid managed care enrollment for both cohorts increased in 2020 (62.4-62.9%). Among PLWH, STR use increased annually from 56.7% in 2016 to 78.3% in 2020 (Figure 2). Conversely, MTR use decreased from 43.3% to 21.7% over the same time period. The increase in STR utilization over time was consistent for both plan types. Mean HIV-specific per member per month (PMPM) pharmacy costs were similar across years for both STR and MTR cohorts, ranging from $2,016-$2,342 for STR cohorts and $2,247-$2,380 for MTR cohorts (Figure 3). Conclusion Between 2019 and 2020, PLWH enrolled in Medicaid shifted from FFS towards managed care. STR use among PLWH enrolled in Medicaid increased from 2016 to 2020 with minimal differences in PMPM pharmacy costs compared with PLWH enrolled in Medicaid receiving MTR. Disclosures Andrew P. Brogan, PhD, ViiV Healthcare: Employee, Salary|ViiV Healthcare: Stocks/Bonds Cindy Garris, MS, ViiV Healthcare: Employee|ViiV Healthcare: Stocks/Bonds Julie Priest, MSPH, ViiV Healthcare: Employee, Salary|ViiV Healthcare: Stocks/Bonds Victoria Divino, BA, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support Jing He, PhD, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support Justin Chen, MHS, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support Mitch DeKoven, MHSA, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support.

1450. Trends in hospitalizations and outpatient visits with early or delayed antibiotic treatment initiation in nontuberculous mycobacterial lung disease

Abstract Background The 2020 treatment guidelines for patients diagnosed with nontuberculous mycobacterial lung disease (NTMLD) recommend antibiotic treatment initiation rather than “watchful waiting” for most patients. Little is known regarding how delayed treatment (DT) may impact healthcare resource utilization (HRU). The goal of this study was to assess HRU with early antibiotic treatment (ET) or DT in NTMLD. Methods We conducted a retrospective observational cohort study using MarketScan claims from July 2014 to June 2020. Inclusion criteria were: ≥ 2 NTMLD medical claims (with date of first NTMLD claim as index date); continuous enrollment spanning 12 months pre–index date (baseline) to ≥ 24 months post–index date; concomitant treatment with antibiotics used in NTMLD, ie, from ≥ 2 drug classes within 28 days of each other; and no tuberculosis diagnosis. Mean time to antibiotic initiation (TT) from index date was used to define ET (TT ≤ 3 months) and DT (TT &amp;gt; 3 months) groups. Trends in hospitalizations (any, respiratory-related) and any outpatient visits at baseline, year 1 (Y1), and year 2 (Y2) post–index date were described. Results A total of 518 patients with NTMLD were included: 395 (76%) ET and 123 (24%) DT patients. ET patients tended to be younger and male; DT patients had a higher prevalence of emphysema, asthma, and bronchiectasis. ET patients had a decrease from baseline in the proportion of patients hospitalized and the mean number of hospitalizations at Y1 and Y2 (Figure 1A and 1B). DT patients had an increase from baseline in the proportion of patients hospitalized and the mean number of hospitalizations at Y1, followed by a decrease in Y2, although the mean number of hospitalizations at Y2 remained higher than at baseline. Similar trends in respiratory-related hospitalizations were observed per patient group (Figure 1C and 1D). ET patients had a decrease from baseline in the proportion of patients and the mean number of emergency room visits at Y1 and Y2, whereas DT patients showed little to no improvement (Figure 2A and 2B). Figure 1.Proportion of patients with (A) any hospitalization and (C) respiratory disease–related hospitalizations with early or delayed treatment for NTMLD. Mean number of (B) any hospitalizations and (D) respiratory disease–related hospitalizations per patient with early or delayed treatment for NTMLDFigure 2.(A) Proportion of patients with any ER visits with early or delayed treatment for NTMLD. (B) Number of ER visits per patient with early or delayed treatment for NTMLD Conclusion During the first 2 years after diagnosis, improvements in hospitalizations and ER visits were observed in patients who received ET, whereas patients who received DT showed little to no improvement from baseline. Disclosures Kevin L. Winthrop, MD, MPH, AN2: Advisor/Consultant|AN2: Grant/Research Support|Insmed: Advisor/Consultant|Insmed: Grant/Research Support|Paratek: Advisor/Consultant|Paratek: Grant/Research Support|Red Hill Biopharma: Advisor/Consultant|Red Hill Biopharma: Grant/Research Support|Spero Therapeutics: Advisor/Consultant Catherine Waweru, PhD, Insmed Incorporated: Employee|Insmed Incorporated: Stocks/Bonds Mariam Hassan, PhD, B. Pharm, Insmed Incorporated: Employee|Insmed Incorporated: Stocks/Bonds Sara Burns, MS, Panalgo: Employee Anjan Chatterjee, MD, MPH, Insmed Incorporated: Employee|Insmed Incorporated: Stocks/Bonds.

Patterns of Comorbidity and Multimorbidity Among Patients With Multiple Sclerosis in a Large US Commercially Insured and Medicare Advantage Population

Background: Comorbidities are common in patients with multiple sclerosis (MS), thus increasing the complexity of disease management and economic burden and worsening their prognosis and quality of life. Real-world evidence comparing comorbidities and multimorbidity patterns of commercially insured vs Medicare enrollees with MS is lacking. Objective: To evaluate the patterns of comorbidity and multimorbidity among patients with MS in a US commercially insured and Medicare Advantage population. Methods: This retrospective observational cohort study was conducted using Aetna health claims data from January 1, 2015, to October 31, 2019. Eligibility criteria were (1) at least 3 MS-related inpatient/outpatient (ICD-10-CM: G35), or disease-modifying therapy claims within 1 year (date of first claim = index date); (2) Aetna commercial health plan or Medicare Advantage medical and pharmacy benefits at least 12 months pre-/post-index; and (3) age 18 and older. Commercially insured patients, Medicare Advantage patients younger than 65 years of age, and Medicare Advantage patients 65 years and older were compared. Results: Among 5000 patients (mean [SD] age, 52.6 [12.9]; 75.2% female), 53% had commercial insurance and 47% had Medicare Advantage (59.2% disabled age &lt;65). Medicare Advantage patients were older (age &lt;65: 53.3 [7.9]; age ≥65: 70.8 [5.2]) vs commercial (age, 45.7 [10.2]), had greater comorbidity burden (Charlson Comorbidity Index; age &lt;65: 1.17 [1.64], age ≥65: 1.65 [1.95]) vs commercial (0.53 [1.02]) (all P &lt; .0001). Symptoms specific to MS (ie, malaise, fatigue, depression, spasms, fibromyalgia, convulsions) were more common among patients younger than 65 (all P &lt; .0001). Age-related and other comorbidities (ie, hypertension, hyperlipidemia, dyspepsia, osteoarthritis, osteoporosis, glaucoma, diabetes, cerebrovascular, cancer) were more common among patients 65 years and older Medicare Advantage (all P &lt; .0001). Multiple comorbidities were highly prevalent (median, 4 comorbidities), particularly among Medicare Advantage patients younger than 65 (median, 6) and Medicare Advantage patients 65 and older (median, 7). Conclusions: Comorbidities and multimorbidity patterns differed between patients with MS with commercial insurance and patients with Medicare Advantage. Multimorbidity was highly prevalent among patients with MS and should be considered in the context of clinical decision making to ensure comprehensive MS management and improve outcomes.

Patterns of Comorbidity and Multimorbidity Among Patients With Multiple Sclerosis in a Large US Commercially Insured and Medicare Advantage Population.

Background: Comorbidities are common in patients with multiple sclerosis (MS), thus increasing the complexity of disease management and economic burden and worsening their prognosis and quality of life. Real-world evidence comparing comorbidities and multimorbidity patterns of commercially insured vs Medicare enrollees with MS is lacking. Objective: To evaluate the patterns of comorbidity and multimorbidity among patients with MS in a US commercially insured and Medicare Advantage population. Methods: This retrospective observational cohort study was conducted using Aetna health claims data from January 1, 2015, to October 31, 2019. Eligibility criteria were (1) at least 3 MS-related inpatient/outpatient (ICD-10-CM: G35), or disease-modifying therapy claims within 1 year (date of first claim = index date); (2) Aetna commercial health plan or Medicare Advantage medical and pharmacy benefits at least 12 months pre-/post-index; and (3) age 18 and older. Commercially insured patients, Medicare Advantage patients younger than 65 years of age, and Medicare Advantage patients 65 years and older were compared. Results: Among 5000 patients (mean [SD] age, 52.6 [12.9]; 75.2% female), 53% had commercial insurance and 47% had Medicare Advantage (59.2% disabled age <65). Medicare Advantage patients were older (age <65: 53.3 [7.9]; age ≥65: 70.8 [5.2]) vs commercial (age, 45.7 [10.2]), had greater comorbidity burden (Charlson Comorbidity Index; age <65: 1.17 [1.64], age ≥65: 1.65 [1.95]) vs commercial (0.53 [1.02]) (all P < .0001). Symptoms specific to MS (ie, malaise, fatigue, depression, spasms, fibromyalgia, convulsions) were more common among patients younger than 65 (all P < .0001). Age-related and other comorbidities (ie, hypertension, hyperlipidemia, dyspepsia, osteoarthritis, osteoporosis, glaucoma, diabetes, cerebrovascular, cancer) were more common among patients 65 years and older Medicare Advantage (all P < .0001). Multiple comorbidities were highly prevalent (median, 4 comorbidities), particularly among Medicare Advantage patients younger than 65 (median, 6) and Medicare Advantage patients 65 and older (median, 7). Conclusions: Comorbidities and multimorbidity patterns differed between patients with MS with commercial insurance and patients with Medicare Advantage. Multimorbidity was highly prevalent among patients with MS and should be considered in the context of clinical decision making to ensure comprehensive MS management and improve outcomes.