Abstract Details

Title Symptom Burden and Healthcare Utilization Before Diagnosis of Transthyretin-Mediated Amyloidosis Among Medicare Beneficiaries

Topic Practice, Policy, and Ethics

Presentation(s) Practice, Policy, and Ethics Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 009

Objective To examine clinical characteristics and healthcare utilization patterns among Medicare beneficiaries in the years before a transthyretin-mediated (ATTR) amyloidosis diagnosis.

Background Patients often experience multiple overlapping clinical manifestations with symptom variability and low disease awareness leading to diagnostic delays and misdiagnoses. Knowledge of the patient symptoms and characteristics before diagnosis may promote earlier recognition.

Design/Methods We identified patients ≥68 years newly diagnosed with ATTR amyloidosis using Medicare Research Identifiable Files. Diagnosis required ≥1 inpatient or ≥2 outpatient claims with ICD-10-CM code for ATTR amyloidosis (E85.1,E85.2,E85.82) between 2016-2018 (ID period) or another amyloidosis form during ID period plus the following between 2011-2018: ≥1 claim for congestive heart failure, cardiomyopathy, or neuropathy; and no chemotherapy, stem cell transplant, or light-chain amyloidosis claims. Index date was date of first amyloidosis claim in ID period. Patients had continuous enrollment 3 years before index (look-back period). Occurrence of selected conditions/symptoms and healthcare utilization was measured during look-back period; demographics and Charlson comorbidity index (CCI) measured 1-year pre-index. Patients with ICD-9/10 amyloidosis codes during look-back or dementia during study were excluded. Controls (ATTR-free) were matched 1:1 to patients with ATTR based on age, gender, region; same index date and enrollment as match.

Results We identified 552 matched ATTR-control pairs. Mean(SD) age was 78.3(6.3) and 64.5% were male. Mean CCI was higher among patients with ATTR vs. controls (3.1 vs. 2.0), as was occurrence of neuropathy (29.2% vs. 11.8%), hypotension (20.7% vs. 11.2%), and gastrointestinal conditions (49.1% vs. 36.8%) during look-back (all, p<0.001). Hospitalizations (54.0% vs. 35.5%) and emergency department visits (56.0% vs.43.5%) were also more frequent among patients with ATTR vs. controls. Evidence of selected symptoms was present up to 3 years pre-diagnosis.

Conclusions

Medicare beneficiaries with ATTR amyloidosis have multiple symptoms and hospitalizations before diagnosis, of which recognition may facilitate earlier diagnosis and treatment.

Authors/Disclosures
Duncan Brown (Akcea Therapeutics, Inc) PRESENTER	Duncan Brown has received personal compensation for serving as an employee of Akcea Therapeutics, Inc. Duncan Brown has received stock or an ownership interest from Akcea Therapeutics, Inc.
Montserrat Vera Llonch	Montserrat Vera Llonch has received personal compensation for serving as an employee of Akcea. Montserrat Vera Llonch has received stock or an ownership interest from Akcea.
	No disclosure on file
	No disclosure on file
Eunice Chang	No disclosure on file
Marian Tarbox (Partnership for Health Analytic Research, LLC)	No disclosure on file
	No disclosure on file
	No disclosure on file

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