Healthcare Resource Use in Patients with Diagnosis of Spinal Muscular Atrophy (SMA) in OptumT US Claims Database

Objective: Describe HRU among patients with diagnostic codes for SMA in a US commercial claims database. Background: SMA is a devastating rare, autosomal recessive neuromuscular disease clinically characterized by severe and progressive muscular atrophy and weakness. HRU in SMA has been shown to be high; however, no published studies have assessed HRU in U.S. commercial claims data. Design/Methods: We conducted a retrospective analysis of Optum’s Clinformatics™ DataMart for MultiPlan, a large US insurance claims database covering approximately 96.7 million lives from 49 plans across seven regions. Patients included in this analysis were born between January 2004 and September 2015 with ≥2 diagnostic codes for SMA (ICD-9: 335.0 or 335.1×) ≥31 days apart. Descriptive statistics were used. Results: 3,146 patients had ≥2 diagnostic codes for SMA ≥31 days apart, of which 342 met inclusion criteria (51% male; average age 2.1 years). Median follow-up time was 19.1 months (average 36.9 months). Top diagnosis claims included lack of coordination (63%), acute respiratory infections (62%), respiratory abnormality (56%), cough (54%), and feeding difficulties/mismanagement (50%). Only 3.8% of patients had a claim for genetic testing. 66.4% had ≥1 inpatient stay (average 3.5 per patient) with a mean length of stay (LOS) of 10 days (median 4 days), and a maximum LOS of 389 days. Top inpatient claims included pneumonia (23%), pulmonary collapse (18%), respiratory failure (16%), gastrostomy status (15%), and esophageal reflux (15%). 64% had ≥1 ER visit. Patients averaged 225 outpatient visits. Claims for g-tubes and tracheostomy occurred in 25% and 7% of patients, respectively. Suction machines (47%), cough assist (38%), and BiPAP/CPAP (36%) were the most prevalent durable medical equipment claims. Conclusions: Patients with diagnostic codes for SMA demonstrated high HRU, consistent with the clinical course of SMA. Further analysis is warranted to understand the economic burden of HRU in SMA to inform research efforts for therapeutic interventions. Study Supported by: Funded by Biogen Disclosure: Dr. Teynor has received personal compensation for activities with Biogen as an employee. Dr. Teynor holds stock/stock options in Biogen. Dr. Hou has received personal compensation for activities with Biogen as an employee. Dr. Zhou has received personal compensation for activities with Biogen Idec. Dr. Zhou has received research support from Biogen Idec. Dr. Hall has received personal compensation for activities with Biogen Idec as an employee. Dr. Hall holds stock and/or stock options in Biogen Idec. Dr. Wells has received personal compensation for activities with Biogen as an employee. Dr. Avendano has received personal compensation for activities with Biogen as an employee. Dr. Avendano holds stock and/or stock options in Biogen.