(80) Healthcare resource utilization and costs among individuals with narcolepsy and idiopathic hypersomnia in the United States

Background: : People with narcolepsy or idiopathic hypersomnia (IH) often have sodium-associated comorbidities which may contribute to economic burden.

Objective: : To quantify healthcare resource utilization (HCRU) and costs for individuals with vs without narcolepsy or IH.

Methods: : Komodo Research Data (01/01/2016–01/31/2024) were used to identify continuously-enrolled individuals diagnosed with narcolepsy or IH (index: first diagnosis) and 2 comparator cohorts without narcolepsy or IH (index: randomly selected), entropy balanced 1:5 on demographics. Individuals with narcolepsy or IH with ≥1 sodium-associated risk factor (RF) in the 12 months pre-index were classified as high-risk (HR); those without any RFs were low-risk (LR). Negative clinical outcomes (NCOs) were new-onset or progression of sodium-associated events occurring after index. Annual all-cause HCRU and costs (2024 USD) were assessed over ≥12 months post-index and compared between individuals with narcolepsy or IH vs comparators and HR vs LR subgroups using log link generalized linear models, reported as incidence rate ratios (IRRs) or mean differences (MDs) with 95% confidence intervals.

Results: : Among individuals with narcolepsy or IH (narcolepsy: n=29,317; IH: n=11,951) vs comparators (non-narcolepsy: n=146,585; non-IH: n=59,755), annual mean inpatient (IP) days (narcolepsy: IRR=2.18 [1.99–2.40]; IH: IRR=1.35 [1.18–1.56]), and outpatient (OP; narcolepsy: IRR=2.13 [2.09–2.16]; IH: IRR=2.17 [2.12–2.22]) and emergency department (ED; narcolepsy: IRR=1.74 [1.66–1.82]; IH: IRR=1.52 [1.42–1.62]) visits were higher. Mean annual costs for individuals with narcolepsy or IH were higher vs comparators, including all-cause (narcolepsy: MD=$9234 [$8815–$9653]; IH: MD=$6966 [$6453–$7478]), RF-related (narcolepsy: MD=$1865 [$1706–$2023]; IH: MD=$1399 [$1250–$1549]), and NCO-related (narcolepsy: MD=$2517 [$2331–$2704]; IH: MD=$1713 [$1470–$1955]) costs. Individuals with narcolepsy or IH were more likely to see specialists (neurology/sleep medicine [narcolepsy: 57.4% vs 12.9%; IH: 57.6% vs 12.3%]; cardiology [narcolepsy: 37.7% vs 22.3%; IH: 38.2% vs 21.2%]). Annual mean IP days, OP and ED visits, and all-cause annual costs were higher in HR individuals (narcolepsy: n=17,227; IH: n=7542) vs LR individuals (narcolepsy: n=12,090; IH: n=4409), with 77%–80% of total mean cost differences attributable to RFs or NCOs.

Conclusions: : Individuals with vs without narcolepsy or IH have higher economic burden, often due to sodium-associated RFs and NCOs. Risk management to mitigate avoidable HCRU and costs is needed.

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