(351) The Economic Burden of Narcolepsy in the United States: Matched Analysis of National Health and Wellness Survey Data

Background: : Narcolepsy is a rare, chronic neurologic disorder that has been associated with negative impacts on patients’ lives and may be associated with increased healthcare resource use and direct medical costs.

Objective: : To compare the economic burden between those with and without narcolepsy.

Methods: : A retrospective, cross-sectional analysis of 2021/2023 US National Health and Wellness Survey data. Propensity-score matching (1:3) adjusted for demographic and health characteristics between those with a physician diagnosis of narcolepsy and those without a diagnosis. Chi-square tests and t-tests compared economic outcomes.

Results: : Before matching, respondents with narcolepsy (n=335; female=56%; mean age, 45.5y; White=68%) and without narcolepsy (n=141,072; female=55%; mean age, 47.8y; White=72%) were included. The narcolepsy cohort had lower socioeconomic status vs those without: less likely to receive college degree (45% vs 52%, p<.05), less likely to be employed full-time (36% vs 46%, p<.001), more likely to receive disability (10% vs 3%, p<.001), more likely to have annual household income <$25,000 (22% vs 12%, p<.001), and more likely to report food insecurity (39% vs 18%, p<.001).

After matching, the narcolepsy cohort reported significantly higher outpatient visits (≥1 visits; 96% vs 84%, p<.001), hospitalizations (≥1 visits; 27% vs 15%, p<.001), and emergency department visits (≥1 visits; 31% vs 22%, p=.001) during prior 6 months vs controls. Those with narcolepsy had $14,492 per-person-per-year in additional medical expenses (average annual medical costs: $37,815 vs $23,323, p<.001). Medical costs were largely driven by hospitalizations ($25,749 vs $16,647 per-person-per-year for narcolepsy vs controls, p<.001).

Of those employed, the narcolepsy cohort reported significantly higher levels of work-related impairment vs controls, including absenteeism (21% vs 12%, p<.001) and presenteeism (44% vs 28%, p<.001). The narcolepsy cohort had an additional $12,853 per-person-per-year due to lost work productivity (average annual indirect costs: $30,075 vs $17,222, p<.001).

Conclusions: : Narcolepsy is associated with reduced education, employment, and income. Those with narcolepsy had double the medical costs than those without. Research and clinical practice should explore ways to mitigate financial burden among those living with narcolepsy with treatments, accommodations, and psychosocial supports.

Sponsorship:: Alkermes, Inc.