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Healthcare Resource Utilization in Refractory MACLD: Comparison of an Amikacin Liposome Inhalation Suspension (ALIS)
Timothy R Aksamit1, Catherine Waweru2, Emily Welch3
1Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA. aksamit.timothy@mayo.edu.
Introduction:
Add-on treatment with amikacin liposome inhalation suspension (ALIS) to a multidrug antibiotic regimen is the only US Food and Drug Administration-approved treatment for adults with refractory Mycobacterium avium complex lung disease (MACLD). In real-world settings, other antibiotics may be added on to treat refractory MACLD. We analyzed healthcare resource utilization in a US patient population who received add-on treatment for refractory MACLD.
Methods:
This was a retrospective claims analysis using Merative™ MarketScan® databases (January 2016 to December 2022). Two patient cohorts were defined: an ALIS and non-ALIS cohort. Index date was date of first prescription with ALIS or non-ALIS antibiotic for refractory MACLD. Hospitalizations (all-cause, respiratory-related, nontuberculous mycobacteria (NTM)-related) and emergency room (ER) visits at 0-6-month and 7-12-month post-index periods were compared with baseline (6-month pre-index period) per cohort. Multivariate logistic regression models compared the odds of hospitalizations or ER visits between cohorts.
Results:
The ALIS and non-ALIS cohorts comprised 116 and 63 patients, respectively. The most common add-on treatments for refractory MACLD in the non-ALIS cohort were parenteral amikacin (41.3%) and moxifloxacin (27.0%). In the ALIS cohort, significant reductions from baseline, as compared with the 7-12-month post-index period, were observed in all-cause (12.1% vs 22.4%), respiratory-related (8.6% vs 20.7%), and NTM-related hospitalizations (9.5% vs 19.8%) (P < 0.05 for all comparisons). There were no significant changes from baseline in hospitalizations at follow-up in the non-ALIS cohort. No significant changes from baseline in ER visits or hospital length of stay were observed in either cohort. Adjusted odds ratios (ORs) of all-cause (OR [95% confidence interval, CI] 0.45 [0.21-0.96]) and respiratory-related hospitalizations (OR 0.44 [0.21-0.96]) were statistically significantly lower in the ALIS cohort compared with the non-ALIS cohort.
Conclusions:
Add-on treatment with ALIS in refractory MACLD may lead to reductions in hospitalizations over time and lower odds of hospitalizations compared with add-on treatment with non-ALIS antibiotics.
Insights
Amikacin liposome inhalation suspension (ALIS) add-on therapy for refractory Mycobacterium avium complex lung disease (MACLD) reduced hospitalizations. Patients on ALIS had fewer all-cause and respiratory hospitalizations compared to those on other antibiotics.
Area of Science:
- Pulmonology
- Infectious Diseases
- Pharmacoeconomics
Background:
- Refractory Mycobacterium avium complex lung disease (MACLD) requires add-on antibiotic treatment.
- Amikacin liposome inhalation suspension (ALIS) is the only FDA-approved treatment for refractory MACLD.
- Real-world data on healthcare resource utilization for refractory MACLD is limited.
Purpose of the Study:
- To analyze healthcare resource utilization in US patients with refractory MACLD receiving add-on treatment.
- To compare hospitalization and emergency room (ER) visit rates between ALIS and non-ALIS cohorts.
- To evaluate the impact of ALIS on reducing healthcare resource utilization.
Main Methods:
- Retrospective claims analysis of Merative™ MarketScan® databases (January 2016 to December 2022).
- Two cohorts: ALIS and non-ALIS add-on treatment for refractory MACLD.
- Comparison of hospitalizations (all-cause, respiratory, NTM-related) and ER visits from baseline to post-index periods using multivariate logistic regression.
Main Results:
- The ALIS cohort (n=116) and non-ALIS cohort (n=63) were analyzed.
- ALIS treatment showed significant reductions in all-cause, respiratory-related, and NTM-related hospitalizations post-index compared to baseline.
- Adjusted odds ratios indicated significantly lower odds of all-cause and respiratory hospitalizations in the ALIS cohort versus the non-ALIS cohort.
Conclusions:
- Add-on ALIS treatment for refractory MACLD may decrease hospitalizations over time.
- ALIS demonstrated lower odds of hospitalization compared to non-ALIS add-on antibiotic treatments.
- Further research into the economic impact of ALIS in refractory MACLD is warranted.
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