Health Plan Enrollment Research Articles

Pulmonary exacerbations in insured patients with bronchiectasis over 2 years.

Patients with bronchiectasis experience persistent symptoms and frequent pulmonary exacerbations; this study investigated the frequency of exacerbations and all-cause hospitalisation. This longitudinal, retrospective, claims database study (IBM® MarketScan®) identified patients aged ≥18 years from 1 July 2015 through 30 September 2018. Exacerbations were identified by bronchiectasis inpatient claim or a healthcare interaction, followed by antibiotic prescription within 7 days. Patients with ≥36 months of continuous health plan enrolment (12 months preceding the first bronchiectasis claim, i.e., baseline period and ≥24 months of follow-up) were included. Patients with cystic fibrosis at baseline were excluded. A multivariable logistic regression model identified baseline factors associated with having ≥2 exacerbations over the 2-year follow-up period. In total, 14 798 patients with bronchiectasis were identified; 64.5% were female, 82.7% were aged ≥55 years and 42.7% had ≥2 exacerbations at baseline. Having ≥2 exacerbations after 2 years was positively associated with chronic macrolide use, long-acting β2 agonist use, gastro-oesophageal reflux disease, heart failure and Pseudomonas aeruginosa. Frequent exacerbations (≥2) at baseline were significantly associated with greater likelihood of experiencing ≥2 exacerbations during the first and second year's follow-up (unadjusted odds ratios 3.35 (95% CI 3.1-3.6) and 2.96 (95% CI 2.8-3.2), respectively). The proportion of patients experiencing ≥1 all-cause hospitalisation cumulatively increased from 41.0% in the first year of follow-up to 51.1% over 2 years' follow-up. Frequent exacerbations in patients with bronchiectasis may increase the likelihood of future exacerbations over 2 years of follow-up, with increased hospitalisation rates over time.

Abstract 4398: Validation of an updated algorithm to identify non-small cell lung cancer (NSCLC) patients in administrative claims databases

Abstract Purpose: Administrative claims data using the ICD-9-CM or ICD-10-CM coding systems are not detailed enough to distinguish between lung cancer subtypes, which presents challenges for real-world research. This study updated and validated a previous treatment-based algorithm that uses claims data to identify NSCLC vs small-cell lung cancer (SCLC) (Turner RM, et al. Front Pharmacol 2017;8:883). Methods: This study used Optum’s de-identified Market Clarity Data (2007-2021) which deterministically links medical and pharmacy claims with electronic health record (EHR) data from providers across the continuum of care. Included patients had lung cancer diagnosis and histology information available in the EHR, which is the gold standard for validation. Patients were required to have ≥3 months of continuous health plan enrollment before and after the diagnosis date. First, to replicate the Turner algorithm, patients were identified between Jun 2014 and Oct 2015 with any first-line NSCLC treatment and no SCLC treatment (Step 1). Next, the Turner algorithm was applied from Nov 2015 to Dec 2020 to evaluate if performance decreased given the approval of immunotherapies since 2015 (Step 2). Finally, the Turner algorithm was updated with NSCLC treatments approved since 2015 in concordance with the latest US treatment guidelines. Algorithm performance at each step was measured using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: Sample sizes and performance statistics for each step are presented in the Table. From Step 1 to Step 2, specificity and PPV decreased while sensitivity and NPV increased. Algorithm performance improved slightly for all measures from Step 2 to Step 3. Conclusions: This updated treatment-based algorithm improves validity and accuracy in identifying NSCLC patients in claims databases and supports its use in real-world research using claims databases when histology data is unavailable. Step 1: Turner replication Step 2: Turner 2015-2020 Step 3: Updated Turner 2015-2020 Date range Jun 2014-Oct 2015 Nov 2015-Dec 2020 Nov 2015-Dec 2020 Sample size 406 2573 2744 Sensitivity 0.873 0.920 0.932 Specificity 0.933 0.865 0.923 PPV 0.987 0.976 0.988 NPV 0.560 0.640 0.673 Citation Format: Sandip Pravin Patel, Rongrong Wang, Summera Qiheng Zhou, Daniel Sheinson, Ann Johnson, Janet Lee. Validation of an updated algorithm to identify non-small cell lung cancer (NSCLC) patients in administrative claims databases. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4398.

Plan Selection, Enrollee Risk, and Health Spending on the Patient Protection and Affordable Care Act Individual Marketplaces, 2019

The Patient Protection and Affordable Care Act (ACA) individual marketplaces are a source of insurance for millions of residents in the US. However, the association between enrollee risk, health spending, and metal tier selection remains unclear. To describe individual marketplace enrollees' metal tier selections by risk score and assess enrollees' health spending by metal tier, risk score, and spending type. This retrospective, cross-sectional study analyzed claims data from the Wakely Consulting Group ACA database, a deidentified claims database built on data voluntarily submitted by insurers. Enrollees with continuous, full-year enrollment in on-exchange or off-exchange ACA-qualified health plans during the 2019 contract year were included. Data analysis was conducted from March 2021 to January 2023. Enrollment totals, total spending, and out-of-pocket cost were calculated, stratified by metal tier and the Department of Health and Human Services (HHS) Hierarchical Condition Category (HCC) risk score for 2019. Enrollment and claims data were obtained for 1 317 707 enrollees (53.5% female; mean [SD] age, 46.35 [13.43] years) across all census areas, age groups, and sexes. Of these, 34.6% were on plans with cost-sharing reductions (CSRs), 75.5% did not have an assigned HCC, and 84.0% submitted at least 1 claim. Compared with enrollees in bronze plans (17.2%), enrollees were more likely to be classified in the top HHS-HCC risk quartile if they selected platinum (42.0%), gold (34.4%), or silver (29.7%) plans. The highest share of enrollees with $0 total spending was noted with the catastrophic (26.4%) and bronze (22.7%) plans, while gold plans had the lowest share (8.1%). Median total spending was lower among bronze plan enrollees ($593; IQR, $28-$2100) vs platinum ($4111; IQR, $992-$15 821) or gold ($2675; IQR, $728-$9070). Within the top risk score decile, CSR enrollees had less average total spending than any other metal tier by more than 10%. In this cross-sectional study of the ACA individual marketplace, enrollees who selected plans with higher actuarial value also had greater mean HHS-HCC risk scores and health spending. The findings suggest these differences may be associated with variation in benefit generosity by metal tier, enrollee's perceptions of future health needs, or other barriers to care access.

TCD screening and spending among children with sickle cell anemia.

National guidelines recommend that children with sickle cell anemia receive annual transcranial Doppler (TCD) screening to assess stroke risk. Our objectives were to estimate the rate of TCD screening among privately insured children with sickle cell anemia, estimate out-of-pocket spending for TCD screening, and evaluate the association between TCD screening and enrollment in high-deductible health plans (HDHPs). Cross-sectional. Using the 2009-2017 IBM MarketScan Commercial Database, we identified children aged 2 to 15 years who met a validated claims-based definition of sickle cell anemia. We calculated the proportion of children receiving annual TCD screening and out-of-pocket spending per TCD screen. Using logistic regression with generalized estimating equations, we modeled the receipt of annual TCD screening as a function of HDHP enrollment, controlling for demographics and year. The 2519 children in the analysis accounted for 7197 person-years of enrollment; 14% of person-years were from HDHP enrollees. During 2009-2017, the proportion of children receiving TCD screening ranged from 40% to 44%. Median out-of-pocket spending for TCD screening was $20 overall and $65 among HDHP enrollees. Out-of-pocket spending exceeded $100 for 27% of all screens and 42% of screens among HDHP enrollees. HDHP enrollment was not associated with TCD screening (adjusted odds ratio, 0.99; 95% CI, 0.85-1.15). Among privately insured children with sickle cell anemia, fewer than half received annual TCD screening. Out-of-pocket spending exceeded $100 for 27% of TCD screens. Although HDHP enrollment was not associated with TCD screening, additional studies are needed to assess whether cost sharing might deter this screening.

Did Access to Ambulatory Care Moderate the Associations Between Visit Mode and Ancillary Services Utilization Across the COVID-19 Pandemic Period?

In recent years, 2 circumstances changed provider-patient interactions in primary care: the substitution of virtual (eg, video) for in-person visits and the COVID-19 pandemic. We studied whether access to care might affect patient fulfillment of ancillary services orders for ambulatory diagnosis and management of incident neck or back pain (NBP) and incident urinary tract infection (UTI) for virtual versus in-person visits. Data were extracted from the electronic health records of 3 Kaiser Permanente Regions to identify incident NBP and UTI visits from January 2016 through June 2021. Visit modes were classified as virtual (Internet-mediated synchronous chats, telephone visits, or video visits) or in-person. Periods were classified as prepandemic [before the beginning of the national emergency (April 2020)] or recovery (after June 2020). Percentages of patient fulfillment of ancillary services orders were measured for 5 service classes each for NBP and UTI. Differences in percentages of fulfillments were compared between modes within periods and between periods within the mode to assess the possible impact of 3 moderators: distance from residence to primary care clinic, high deductible health plan (HDHP) enrollment, and prior use of a mail-order pharmacy program. For diagnostic radiology, laboratory, and pharmacy services, percentages of fulfilled orders were generally >70-80%. Given an incident NBP or UTI visit, longer distance to the clinic and higher cost-sharing due to HDHP enrollment did not significantly suppress patients' fulfillment of ancillary services orders. Prior use of mail-order prescriptions significantly promoted medication order fulfillments on virtual NBP visits compared with in-person NBP visits in the prepandemic period (5.9% vs. 2.0%, P=0.01) and in the recovery period (5.2% vs. 1.6%, P=0.02). Distance to the clinic or HDHP enrollment had minimal impact on the fulfillment of diagnostic or prescribed medication services associated with incident NBP or UTI visits delivered virtually or in-person; however, prior use of mail-order pharmacy option promoted fulfillment of prescribed medication orders associated with NBP visits.

317 Comparative risk of venous thromboembolism (VTE) among patients with atopic dermatitis (AD) or other immune-mediated diseases: a cohort study using United States claims data

Abstract Patients with rheumatoid arthritis (RA) or inflammatory bowel disease (IBD) are at increased risk for thrombotic events, but less is known about the underlying risk of VTE with immune-mediated skin conditions. The objective of our study was to describe the incidence of VTE among patients diagnosed with AD and compare VTE incidence among patients with other immune-mediated inflammatory diseases, as well as among individuals without such conditions. This retrospective, observational, comparative cohort study used a large national administrative claims database Optum® (Clinformatics® Data Mart). Adults (aged ≥18 years) diagnosed with AD, RA, IBD (Crohn’s disease [CD] or ulcerative colitis [UC]) or other immune-mediated diseases during 2010–2019 were included. Disease cohorts were not mutually exclusive. A non-diseased control population with no such diagnoses was matched 1 : 1 to patients in the AD cohort by age, sex and calendar time of cohort entry. All patients had to have at least 12 months of enrolment (baseline) before a confirmed diagnosis (or matched cohort entry date for controls) and at least 1 day of follow-up data following diagnosis. All patients received normal clinical care and were followed until the earliest VTE event, end of health plan enrolment, death or end of data availability (30 June 2021). The primary outcome was the incidence of VTE (deep vein thrombosis [DVT] or pulmonary embolism [PE]) defined as an inpatient hospitalization with a VTE diagnosis and length of stay ≥1 day or an outpatient VTE diagnosis followed by initiation of an anticoagulant within 7 days. Incidence per 100 person-years (PY) and 95% CI were calculated. Crude and adjusted hazard ratios (HRs) were determined using Cox proportional hazards regression models and adjusted for demographic and comorbid disease factors. The secondary outcome was the incidence of VTE limited to inpatient events. A total of 1,098,633 adults with AD were included in the analysis; the mean (SD) age was 54.1 (18.5) years, 65.3% were female and 1.1% had a history of VTE. A total of 15,456 VTE events (primary outcome) were reported among patients with AD during 2,113,668.9 PY for a crude incidence (95%CI) of 0.73 (0.72, 0.74) cases/100 PY. The incidence of VTE was 1.33 (1.30, 1.36) cases/100 PY among patients with RA or IBD (n = 578,021) and 0.59 (0.58, 0.60) cases/100 PY among AD-matched controls. The adjusted risk for VTE was higher among patients with RA or IBD compared with patients with AD with an adjusted HR (95% CI) of 1.46 (1.43, 1.49). Patients with AD had a slightly higher risk for VTE compared with AD-matched controls with an adjusted HR of 1.09 (1.06, 1.12). Similar results were observed when DVT and PE were assessed separately. Patients with CD or UC had the highest risk for VTE relative to patients with AD with an adjusted HR of 1.61 (1.54, 1.69) and 1.57 (1.5, 1.63), respectively. Patients with RA also had a higher risk for VTE relative to patients with AD with an adjusted HR of 1.42 (1.38–1.46). Similar results were also observed when the assessment of the incidence and risk of VTE was limited to inpatient events. Patients with RA or IBD had a higher risk of VTE compared with patients with AD. The risk of VTE was slightly higher among patients with AD compared with AD-matched controls. Because VTE risk is increased in RA and IBD during periods of active disease, observed rates may depend on the proportion of patients with uncontrolled disease. Characterization of baseline VTE risk among patients with AD may better inform treatment benefit–risk assessments and shared decision-making.

Trajectories of medication use and polypharmacy among children with cerebral palsy.

BACKGROUND: Children with cerebral palsy (CP) may have chronic exposure to polypharmacy to address several medical needs, but there is little research on the topic to inform surveillance methods and clinical practice. OBJECTIVE: To identify the trajectories of medication number and pediatric polypharmacy (≥2 concurrent medications) exposure over 3.5 years among children with CP. METHODS: This cohort study used commercial claims from January 1, 2015, to December 31, 2018 (4-year period). Children with CP, aged 5-18 years by January 1, 2016, and with continuous health plan enrollment for all 4 years, were included and categorized as with or without co-occurring neurological/ RESULTS: Of the 1,252 children with CP, 600 were in the CP only cohort (mean [SD]; age, 11.4 [4.1] years; 46.0% female) and 652 were in the CP + NDDs cohort (age, 11.9 [4.1] years; 41.3% female; 32.7% had ≥2 of the NDDs). For the primary GBTM, 3 trajectory groups were identified for CP only: on average, no prescribed medications (69.7% of the cohort), 1 medication/month (24.8%), and 4 medications/month (5.5%). Five trajectory groups were identified for CP + NDDs: 0 (22.4%), 1 (25.6%), 2 (25.2%), 4 (18.4%), and 6 (8.4%) prescribed medications/month. For the secondary GBTM, 3 trajectory groups were identified for CP only: 80.5% were characterized as negligible probability of polypharmacy exposure, 10.8% as low probability, and 8.7% as high probability. Five trajectory groups were identified for CP + NDDs: 37.9% as negligible probability of polypharmacy exposure, 32.8% as constantly high probability, and 29.2% as changing probability (eg, increasing/decreasing). CONCLUSIONS: Children with CP are chronically exposed to differing levels of polypharmacy. Findings can help establish polypharmacy surveillance practices. Studies need to determine if polypharmaceutical strategies are balanced to optimize health and development for children with CP. DISCLOSURES: Dr Whitney is supported by the University of Michigan Office of Health Equity and Inclusion Diversity Fund. The funding source had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

Clinical and Economic Outcomes in Low-risk Pulmonary Embolism Patients Treated with Rivaroxaban versus Standard of Care

BackgroundL Rivaroxaban, a fixed-dose oral direct factor Xa inhibitor, does not require continuous monitoring and thus reduces the hospital stay and economic burden in low-risk pulmonary embolism (LRPE) patients. Study Question: What is the effectiveness of rivaroxaban versus the standard of care (SOC; low-molecular-weight heparin, unfractionated heparin, warfarin) among LRPE patients in the Veterans Health Administration? Study Design: Adult patients with continuous health plan enrollment for ≥12 months pre- and 3 months post-inpatient PE diagnosis (index date=discharge date) between October 1, 2011- June 30, 2015 and an anticoagulant claim during the index hospitalization were included. Measures and Outcomes Patients scoring 0 points on the simplified Pulmonary Embolism Stratification Index were considered low-risk and were stratified into SOC and rivaroxaban cohorts. Propensity score matching (PSM) was used to compare hospital-acquired complications (HACs), PE-related outcomes (recurrent venous thromboembolism, major bleeding, and death), and healthcare utilization and costs between the rivaroxaban and SOC cohorts. Results: Among 6746 PE patients, 1918 were low-risk; of these, 73 were prescribed rivaroxaban, 1546 were prescribed SOC, and 299 were prescribed other anticoagulants during the index hospitalization. After 1:3 PSM, 64 rivaroxaban and 192 SOC patients were included. During the index hospitalization, rivaroxaban users (versus SOC) had similar inpatient length of stay (LOS; 7.0 vs 6.7 days, standardized difference [STD]=1.8) but fewer HACs (4.7% vs 10.4%; STD: 21.7). In the 90-day post-discharge period, PE-related outcome rates were similar between the cohorts (all p>0.05). However, rivaroxaban users had fewer outpatient (15.9 vs 20.4; p=0.0002) visits per patient as well as lower inpatient ($765 vs $2,655; p<0.0001), pharmacy ($711 vs $1,086; p=0.0033), and total costs ($6,270 vs $9,671; p=0.0027). Conclusions: LRPE patients prescribed rivaroxaban had similar index LOS and PE-related outcomes, but fewer HACs, and lower total costs than those prescribed SOC.

Racial or ethnic differences on treatment adherence and persistence among patients with inflammatory bowel diseases initiated with biologic therapies

BackgroundInflammatory bowel disease (IBD) is a chronic disease with the potential for significant morbidity in case of suboptimal treatment (e.g. low treatment adherence). In spite of immense research in IBD, literature on association of IBD with race/ethnicity is fragmented. In this study, we aimed to evaluate the association between race/ethnicity and treatment adherence and persistence among patients with Crohn’s disease (CD) or ulcerative colitis (UC) initiated with biologic therapies.MethodsThis observational, retrospective study utilized the Optum Clinformatics (Optum) Extended Data Mart Socioeconomic Status (SES) database. Adult patients with ≥ 2 medical claims for CD or UC diagnosis, ≥ 1 medical or pharmacy claim for corresponding FDA-approved biologic therapy, and a ≥ 12-month pre-index (index date: date of the first biologic medical/pharmacy claim) continuous health plan enrollment were included. Treatment adherence was measured as the proportion of days covered of ≥ 80% and treatment persistence by the number of days from the index date to the biologics discontinuation date. Switching among biologics was allowed for both treatment adherence and treatment persistence. Multivariable regression analyses were performed to evaluate the association between race/ethnicity and treatment adherence/persistence.ResultsAmong patients with CD (N = 1430) and UC (N = 1059) included, majority were White (CD: 80.3%, UC: 78.3%), followed by African Americans (AA; CD: 10.5%, UC: 9.7%). Among patients with CD, AA were significantly less likely to adhere to biologics (adjusted OR [95%CI]: 0.61 [0.38; 0.99]) and more likely to discontinue biologics earlier (adjusted HR [95%CI]: 1.52 [1.16; 2.0]) during the follow-up period compared to Whites, after adjusting for other patient sociodemographic and clinical characteristics. Among patients with UC, no significant differences in the treatment adherence/persistence were observed between different races/ethnicities.ConclusionsPatients with CD were found to display racial differences in the treatment adherence and persistence of biologics, with significantly lower adherence and earlier discontinuation in AA compared to Whites. Such differences were not observed in patients with UC. Future studies are warranted to understand the possible reasons for racial differences, particularly in patients with CD.

2145. Economic Burden of Congenital Cytomegalovirus Infection in Commercially- and Medicaid-insured Patients in the United States

Abstract Background Congenital cytomegalovirus (cCMV) infection is the leading infectious cause of congenital birth defects. Approximately 20-25% of infants born with cCMV develop long-term health complications such as hearing loss, developmental issues, and microcephaly. Despite this, studies on the economic burden of cCMV are limited. The aim of this study is to assess the healthcare resource utilization (HRU) and cost burden among a sample of cCMV patients in the US using insurance claims data. Methods This retrospective study utilized IBM Watson Health MarketScan® Commercial Claims and Encounters and Multi-State Medicaid data from January 1, 2010 to December 31, 2019. Separately for each payer population, patients were included in the cCMV cohort if their first diagnosis (index date) of cCMV (ICD-9: 771.1; ICD-10: P35.1) or CMV (ICD-9: 78.5; ICD-10: B25.x) was within 1 month of birth. The index date for non-cCMV controls was selected at random from all medical claims within 1 month of birth. cCMV patients were matched 1:1 to controls on demographics, insurance type, birth year, and index year. All patients were required to have ≥ 1 year of continuous health plan enrollment post-index (study period). HRU and costs in 2021 USD ($) were summarized over the study period. Costs for birth admissions were also described. Results 195 Commercial and 549 Medicaid matched pairs were included in the analyses. Mean ± SD age at first diagnosis was 8.4 ± 8.6 days and 5.9 ± 7.8 days for Commercial and Medicaid cases, respectively. Mean birth length of stay for Commercial and Medicaid cases was 24 days (vs. 5 for controls), with mean birth admission costs of $149,192 (vs. $17,996) and $49,885 (vs. $5,052), respectively. On average, cCMV patients had higher study period HRU and costs compared to controls (Table 1). Excess costs due to cCMV were estimated at $33,223 for Commercial and $9,748 for Medicaid. Conclusion cCMV patients have substantial HRU and costs during the 1-year post-diagnosis. While the majority of patients did not require hospitalization, inpatient care contributed substantially to the overall cost burden. Future studies should evaluate longer-term costs beyond the first year as well as the reasons underlying the high economic burden among cCMV patients. Disclosures John D. Diaz-Decaro, PhD, MS, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Gail J. Demmler-Harrison, MD, Elsevier: Book royalties|Merck: Grant/Research Support|Microgen: Advisor/Consultant|Microgen: Grant/Research Support|Moderna: Advisor/Consultant|UpToDate Wolters Kluwer Health: Royalties Jessica R. Marden, ScD, MPH, Moderna, Inc.: Advisor/Consultant Annika Anderson, MPH, Moderna, Inc.: Advisor/Consultant Sandeep Basnet, MD, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Katherine Gaburo, n/a, Moderna, Inc.: Advisor/Consultant Danielle Peterson, n/a, Moderna, Inc.: Advisor/Consultant Kosuke Kawai, ScD, MS, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Noam Kirson, PhD, Moderna, Inc.: Advisor/Consultant Urvi Desai, PhD, Moderna, Inc.: Advisor/Consultant Philip Buck, PhD, MPH, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds.

Impact of initiation of amikacin liposome inhalation suspension on hospitalizations and other healthcare resource utilization measures: a retrospective cohort study in real-world settings

BackgroundMycobacterium avium complex lung disease (MAC-LD) is an infection that is increasing in frequency, associated with substantial disease burden, and often refractory to treatment. Amikacin liposome inhalation suspension (ALIS) is the first therapy approved for refractory MAC-LD. In the CONVERT study of adult patients with refractory MAC-LD, adding ALIS to a multidrug background regimen showed evidence of MAC infection elimination in sputum by month 6, which was maintained in most patients through the end of treatment (≤ 12 months post-conversion). This study assessed changes in healthcare resource utilization (HCRU) among patients initiating ALIS in real-world settings.MethodsThis retrospective cohort study of the All-Payer Claims Database (October 2018–April 2020) included patients aged ≥ 18 years with ≥ 1 pharmacy claim for ALIS and ≥ 12 months of continuous health plan enrollment pre- and post-ALIS initiation. Respiratory disease-related (and all-cause) HCRU (hospitalizations, length of stay [LOS], emergency department [ED] visits, and outpatient office visits) were compared 12 months pre- and post-ALIS initiation. Outcomes were reported at 6-month intervals; 0–6 months pre-ALIS initiation was the reference period for statistical comparisons.ResultsA total of 331 patients received ALIS, with HCRU highest in the 6 months pre-ALIS initiation. Compared with 26.9% during the reference period, respiratory-related hospitalizations decreased to 19.3% (P < 0.01) and 15.4% (P < 0.0001) during 0–6 and 7–12 months post-ALIS initiation, respectively. Mean number of respiratory disease-related hospitalizations per patient/6-month period decreased from 1.0 (reference period) to 0.6 (P < 0.0005) at both timepoints post-ALIS initiation. A similar pattern was observed for all-cause hospitalizations and hospitalizations per patient/6-month period (both P < 0.005). Reductions in all-cause and respiratory disease–related LOS post-ALIS initiation were significant (both P < 0.05). ED visits were few and unchanged during the study. Significant reductions per patient/6-month period in all-cause and respiratory-related outpatient office visits were observed post-ALIS initiation (all P < 0.01).ConclusionsIn this first real-world study of ALIS, respiratory disease-related (and all-cause) hospitalizations and outpatient visits were reduced in the 12 months following ALIS initiation. The results of this study provide HCRU-related information to better understand the impact of initiating ALIS treatment.Trial registrationNot appliable.

Colorectal screening among average risk individuals in the United States, 2015–2018

Colorectal cancer screening rates are important metrics for public health and quality indicators for health care systems; however, published estimates of colorectal cancer screening rates often include both high-risk and average-risk patients, and the use of different epidemiologic methods makes between-study comparisons tenuous. The objective of this study was to measure the proportion of average-risk American adults who are up to date with colorectal cancer screening guidelines and examine the impact of evaluation methods on screening rate estimates. This repeated cross-sectional study used administrative claims to identify individuals aged 50–75 years between 2015 and 2018 with ≥ 1-year of continuous health plan enrollment. Sensitivity analyses to replicate prior studies in the literature included: 1) retrospective cohort study requiring ≥ 10 years of continuous enrollment to identify the most current screening rates (2018), and 2) inclusion of individuals with higher colorectal cancer risk. A total of 2,579,898; 2,948,064; 3,312,882; and 2,752,864 individuals were included in the 2015, 2016, 2017, and 2018 populations, respectively. In the cross-sectional sample, the proportion of individuals with up-to-date colorectal cancer screening was 51.8%, 51.3%, 51.0%, and 51.1% in 2015, 2016, 2017, and 2018, respectively. The inclusion of high-risk individuals increased estimates approximately 37%. Using a retrospective cohort design, 67.5% of average-risk individuals were up to date in 2018. This study demonstrated the impact of methodological differences on rate estimates. Efforts to track screening rates require transparency in measurement methods to accurately evaluate progress in improving rates.

Effect of Patient Characteristics on Uptake of Screening Using a Mailed Human Papillomavirus Self-sampling Kit

Mailing human papillomavirus (HPV) self-sampling kits increases cervical cancer screening participation, but effects may differ across subpopulations. Subpopulation data can inform US health care system implementation. To identify patient characteristics that modify effectiveness of a mailed kit intervention at increasing screening. This was a secondary analysis of data from the Home-Based Options to Make Cervical Cancer Screening Easy (HOME) randomized clinical trial conducted from 2014 to 2018 at Kaiser Permanente Washington. Data analysis was performed from March 2018 to May 2022. Individuals aged 30 to 64 years with female sex, health plan enrollment longer than 3 years and 5 months, a current primary care clinician, and no Papanicolaou test within the prior 3 years and 5 months were identified through electronic medical records and randomized (1:1) to the control or intervention group. The control group received usual care Papanicolaou screening reminders and outreach. The intervention group received usual care plus an unsolicited mailed HPV self-sampling kit. Screening uptake was captured within 6 months after randomization. Baseline patient characteristics (age, race, ethnicity, travel time to clinic, income, body mass index, tobacco use, health plan enrollment duration, time since last Papanicolaou test, mammography, comorbidities, and colorectal cancer screening adherence) were extracted from the electronic medical record. Of 19 734 individuals (mean [SD] age, 50.1 [9.5] years; 14 129 [71.6%] White), 9843 were randomized to the intervention group, and 9891 were randomized to the control group. Screening uptake was 26.3% (2592 of 9843 individuals) in the intervention group vs 17.4% (1719 of 9891 individuals) in the control group (relative risk [RR], 1.51; 95% CI, 1.43-1.60). Although absolute differences in uptake by group varied little by screening history, relative effects were greater with longer vs shorter time since last Papanicolaou test (no prior Papanicolaou test: RRs, 1.85-3.25; ≥10 years: RR, 2.78; 5-10 years: RRs, 1.69-1.86; <5 years: RRs 1.29-1.37). Relative effects were greater in participants overdue (RR, 2.03; 95% CI, 1.73-2.38) vs up-to-date with mammography (RR, 1.53; 95% CI, 1.41-1.67), although absolute difference was greater in the up-to-date group. Differences by age were not significant, with RRs of 1.33 to 1.48 across 5-year age groups in participants 30 to 54, vs 1.60 (95% CI, 1.40-1.82) in participants 55 to 59 and 1.77 (95% CI, 1.56-2.01) in participants 60 to 64 years. Among those mailed kits, there were differences in kit use vs in-clinic screening by age, race, plan enrollment duration, underscreening duration, and colorectal cancer screening adherence. In this secondary analysis of a randomized clinical trial, clinically important improvements in screening uptake were observed for all subgroups. Differences in magnitude of intervention effect and kit use highlighted opportunities to optimize HPV self-sampling for priority groups. ClinicalTrials.gov Identifier: NCT02005510.

Abstract 12823: Racial Disparities and Geographic Variation in Anticoagulant Treatment Among Medicare Beneficiaries With Non-Valvular Atrial Fibrillation in the United States

Introduction: Little is known about racial disparities and the geographic variation in oral anticoagulant (OAC) use throughout the United States (US) since the approval of direct oral anticoagulants (DOACs) as a safe alternative treatment compared to warfarin for non-valvular atrial fibrillation (NVAF). Methods: Patients with NVAF were selected from the US Centers for Medicare &amp; Medicaid Services claims database (01JAN2013 to 31DEC2016). The final population consisted of patients with 12 months of health plan enrollment before and after the NVAF diagnosis and with a baseline CHAD 2 S 2 -VASc ≥ 2. Each patient was assigned a 3-digit zip code based on their primary residence. Results were stratified by race. Geographic variations within each race and differences between races were visualized using ArcGIS Pro software. Results: Of the 2,756,097 patients with NVAF and CHAD 2 S 2 -VASc ≥ 2, majority (88.9%) were White, and 6.3% were Black. Age and HASBLED scores ranged from 79 (Black) to 81 (White) and 3.4 (White) to 3.9 (Black), respectively. The CHAD 2 S 2 -VASc and CCI scores ranged from 5.1 (White) to 5.5 (Black) and 3.0 (White) to 4.3 (Black), respectively. In general, Black patients had a higher untreated rate with an OAC than Whites (Figures 1 and 2). There were also geographic variations in treatment rates mostly noted among Whites with lower rates in the mid-west compared to the south and west (Figure 2). Conclusion: OAC use by race varies considerably by 3-digit zip code in the US. Higher untreated rates and use of warfarin over DOACs in the Black population indicate a potential target for further research into disparities between races in availability of anticoagulant treatment.

High deductible health plans and spending among families with a substance use disorder

BackgroundThe United States faces an ongoing drug crisis, worsened by the undertreatment of substance use disorders (SUDs). Family enrollment in high deductible health plans (HDHPs) and the resulting increased cost exposure could exacerbate the undertreatment of SUD. This study characterized the distribution of health care spending within families where a member has a SUD and estimated the association between HDHPs and family health care spending. MethodsUsing commercial claims and enrollment data from OptumLabs (2007–2017), we identified a treatment group of enrollees whose employers began offering an HDHP and comparison group whose employers never offered an HDHP. We used a difference-in-differences analysis that compared health care spending in families at firms that did vs. did not offer an HDHP before and after the HDHP offer. All models were adjusted for employer and year fixed effects, as well as family demographics, size, and chronic conditions. ResultsOur sample was comprised of 317,353 family-years. Family members with a SUD, on average, contributed an outsized proportion of total family health care expenditures (56.9% in a family of three). Offering a family HDHP was associated with a 6.1% reduction (95% confidence interval [CI]: 9.7–2.6%) in the probability of families having any SUD-related expenditures. The HDHP offer was associated with a $1546 reduction in family total expenditures and a $1185 reduction for the individual with SUD (95% CI: −2272 to −821 and −1845 to −525, respectively). ConclusionsThe increased prevalence of family enrollment in HDHPs may further the existing issue of undertreatment of SUDs.

Real-world opioid use among patients with migraine enrolled in US commercial insurance and risk factors associated with migraine progression.

BACKGROUND: Migraineurs may be categorized as having episodic migraine (EM: < 15 headache days/month) or chronic migraine (CM: ≥ 15 days/month for > 3 months with ≥ 8 days/month having features of migraine). Opioid use has been linked to progression from EM to CM. OBJECTIVE: To describe the utilization of opioid prescriptions among patients with migraine, to determine the association between opioid use and migraine progression, and to explore demographic and clinical risk factors for migraine progression. METHODS: This retrospective cohort study used Optum's deidentified Clinformatics Data Mart Database from January 2015 to December 2018. Adult patients with a migraine diagnosis and continuous health plan enrollment were included. Opioid use was measured by average daily morphine equivalent dose, also known as morphine milligram equivalent (MME). Descriptive statistics were used to summarize the opioid use by patient demographic and clinical characteristics. A Cox proportional hazards model with stepwise selection was used to determine the risk factors of new-onset CM. RESULTS: Overall, 35% of patients with migraine (27,331 of 78,134) received prescription opioids (> 0 MME/day) during the 12-month follow-up period. Higher opioid dosage was found in patients who had CM and comorbidities of interest. Compared with patients with EM, patients with CM were twice as likely to receive at least 20 MME/day (CM 3.8% vs EM 1.9%) and had a higher median opioid day supply (CM 20 vs EM 10) during follow-up. About 7% of patients with CM with at least 1 opioid prescription had at least 50 MME/day in any 90-day period during follow-up. A significant association was found between MME level and the likelihood of new-onset CM. Additional significant risk factors of migraine progression included younger age, female sex, South and West regions, and having a diagnosis of medication overuse headache, depression, back pain, or fibromyalgia (all P < 0.05). CONCLUSIONS: Despite guidelines and the availability of more migraine-specific treatments, opioids are still commonly prescribed to patients with migraines in real-world practice, especially for those with CM. In this study population, a higher risk of new-onset CM was associated with receiving higher opioid doses.

OR28-3 Ethnic Differences in Albuminuria among Adults with Diabetes and Normal Range Estimated Glomerular Filtration Rate (eGFR).

Abstract Background Diabetic kidney disease (DKD) develops in approximately 40% of adults with diabetes and is the leading cause of chronic kidney disease (CKD). Less is known about early DKD, particularly in ethnically diverse populations that include Black, Hispanic/Latinx, and Asian Americans. Current guidelines recommend that patients with diabetes be screened annually for DKD. Albuminuria is the first sign of CKD and is associated with CKD progression, cardiovascular events, and death. This study characterizes ethnic differences in the prevalence of albuminuria in a diverse population of adults with diabetes with normal range eGFR. Methods This retrospective study was conducted in a large healthcare system where patients with diabetes are annually monitored for DKD. We identified adults with diabetes aged 45-74 years, eGFR ≥60 mL/min/m2 based on serum creatinine (using the CKD-EPI equation without race), and assessment of urine albumin-creatinine ratio (ACR), urine protein-creatinine ratio (PCR) and/or urine protein dipstick in 2015. Albuminuria was based on urine ACR (95%), otherwise, from urine PCR (1%) converted to ACR, and, if unavailable, from urine protein dipstick (4%) converted to ACR. The cohort was restricted to patients with diabetes onset after health plan enrollment to calculate diabetes duration. Hypertension was identified by clinical diagnosis. Modified Poisson regression with robust variance was used to examine the association of ethnicity and albuminuria, reporting relative risk (RR) with 95% confidence intervals (CI). Results Among 79,184 adults with diabetes, eGFR ≥60, and urine albumin/protein assessment (age 60.5 ±7.7y, 54.0% male), 40.3% were non-Hispanic White, 9.6% Black, 26.3% Asian/Pacific Islander (PI), and 21.0% Hispanic/Latinx race/ethnicity. 69.9% had hypertension. Overall, 81.7%, 13.8%, and 4.6% had urine ACR &amp;lt;30 (normal), 30 to &amp;lt;300 (microalbuminuria), and ≥300 mg/g (macroalbuminuria), respectively, with albuminuria higher in males than females. By race/ethnicity, the prevalence of [micro/macroalbuminuria] was [15.7/5.4%] Asian/PI, [13.8/4.8%] Black, [13.1/4.5%] Hispanic/Latinx, and [12.8/4.1%] non-Hispanic Whites. Among Asian/PIs, prevalence ranged from [19.5/8.4%] Hawaiian/PI and [18.2/7.1%] Filipino to [14.5/3.6%] Chinese and [11.2/3.4%] South Asian. In multivariable analyses, adjusting for age, sex, diabetes duration, and hypertension, Asian/PI (RR 1.3, CI 1.2-1.3) was associated with higher risk of albuminuria compared to non-Hispanic White, but Black (RR 1.0) and Hispanic/Latinx (RR 1.0) were not. Among Asian/PIs, with Chinese as reference, Filipino (RR 1.3, CI 1.2-1.4) and Hawaiian/PI (RR 1.4, CI 1.3-1.6) had higher risk, South Asian had lower risk (RR 0.7, CI 0.7-0.8), and Japanese and Southeast Asian had similar risk of albuminuria. Conclusions The risk of albuminuria in adults with diabetes and normal range eGFR was higher in Asian/PI adults. Among Asian/PIs, the risk was higher among Filipino and Hawaiian/PI and lower in South Asian compared to Chinese adults, supporting the importance of disaggregating Asians when examining microvascular outcomes. Future studies should examine ACEI/ARB use and albuminuria progression. Presentation: Tuesday, June 14, 2022 10:15 a.m. - 10:30 a.m.

DEMOGRAPHICS AND CLINICAL CHARACTERISTICS OF PATIENTS WITH EOSINOPHILIC ESOPHAGITIS: A US-BASED INSURANCE CLAIMS DATA ANALYSIS

<h3>Introduction</h3> Real-world data on demographics and clinical characteristics of patients with eosinophilic esophagitis (EoE) are limited. We described patient characteristics, clinical symptoms, and comorbidities in US patients with newly-diagnosed EoE. <h3>Methods</h3> Retrospective analysis of 2017–2021 US MarketScan Commercial and Medicare administrative claims data including EoE patients with ≥12 months' continuous health plan enrollment pre- and post-first observed EoE diagnosis (index date). Demographic characteristics, clinical symptoms, and comorbidities pre-index in patients with incident (newly diagnosed) EoE were reported overall and stratified by age at EoE index date: <12 years (children), ≥12–17 years (adolescents) and ≥18 years (adults). Statistics were descriptive. <h3>Results</h3> 12,694 patients with incident EoE were identified and included (63.5% male; mean [SD] age 38.2 [16.5] years). The most common symptoms observed pre-index were dysphagia (38.0%), acid reflux (36.5%), and abdominal pain (25.9%). Mean (SD) days from first recorded chest pain and abdominal pain diagnosis to EoE diagnosis were 150.1 (114.6) and 146.3 (114.9), respectively, longer than EoE-specific symptoms such as dysphagia (82 [90.2]). Time from onset of dysphagia to EoE diagnosis was shorter in adults than in children and adolescents. Common comorbidities at index are presented in the <b>Figure</b>. Children and adolescents have a higher frequency of concomitant allergic diseases compared with adults. <h3>Discussion</h3> The presence of concomitant diseases and symptoms such as dysphagia and abdominal pain suggests a high disease burden. Comorbidities, presence of non-specific symptoms, duration of symptoms and patient age should be considered for a timely diagnosis of EoE.

Real-World Cost of Nasal Polyps Surgery and Risk of Major Complications in the United States: A Descriptive Retrospective Database Analysis.

Endoscopic nasal polyp (NP) surgery is a treatment option for patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Previous studies report NP surgery costs of $8000-13,000 and risk of major complications of NP surgery of ~0.1-1%. Limited contemporary data for costs and complications associated with NP surgery in US clinical practice are available. IQVIA PharMetrics Plus claims data were used to identify patients with NP surgery in 2019 with ≥3 years continuous baseline health-plan enrollment prior to index date (date of first eligible NP surgery) and ≥30 days continuous enrollment after index (follow-up). In this descriptive analysis, total costs of NP surgery were estimated as all medical costs on the index date (or during the entire hospital stay for patients who received surgery in the inpatient setting). Total medical costs (all-cause) were estimated for all medical services occurring from the index date to the index date +9 or +29 days (10-day and 30-day). Major complication was defined as cerebrospinal fluid (CSF) leak, orbital injury, or major hemorrhage within 30 days of index. Of 6311 patients, median age was 46 years (interquartile range: 34-56); 59.7% were male; 88.2% had no NP surgery in the prior 3 years; 63.7% had allergic rhinitis, and 37.1% had asthma. Mean (SD) total medical cost of surgery was $14,697 (11,679) and mean (SD) 10-day total medical cost was $15,401 (11,968). Major complications occurred in 102 (1.7%) patients. Total medical costs and 10-day costs were higher in patients with major complications than those without ($23,605 [19,264] vs $15,251 [11,741]). In this descriptive analysis, NP surgery costs and rates of major surgical complications were updated using recent real-world data in the US. Results indicated that NP surgery complication rates were numerically higher than previously reported.

Association between initiation of fluoroquinolones and hospital admission or emergency department visit for suicidality: population based cohort study

ObjectiveTo evaluate the association between initiation of fluoroquinolones and hospital admission or emergency department visit for suicidality.DesignPopulation based cohort study.SettingIBM MarketScan database, USA.Participants2 756 268 adults (≥18 years) who initiated...