OBJECTIVES: Most real-world estimates of AL amyloidosis burden are limited by reliance on non-specific ICD-9 diagnosis codes. We aimed to examine determinants of higher healthcare cost and inpatient hospitalization in AL amyloidosis, using the specific ICD-10 code.

METHODS: This retrospective analysis used Merative^® MarketScan^® and IQVIA Pharmetrics Plus^® databases to identify adult patients (existing or newly diagnosed) with ≥1 inpatient or ≥2 outpatient claims for AL amyloidosis (ICD-10-CM code E85.81) in any diagnosis field during 1/1/2019-12/31/2019 in the United States. Continuous enrollment in a health plan for the duration was required. To identify the determinants for higher cost and hospitalization, linear and logistic regression models were conducted respectively. We used a forward selection method by sequentially adding significant independent variables – age group, gender, region, severity of AL amyloidosis (defined as the presence of advanced cardiac or renal conditions).

RESULTS: We identified 591 patients: mean age of 60.8 years, 42.6% females. Determinants for higher healthcare cost included: having severe AL amyloidosis ($53,200 higher than non-severe, p=0.009); and being 18-34 (estimate: $151,729 higher, p=0.028), 35-54 ($92,184 higher, p<0.001), or 55-64 ($72,697 higher, p<0.001) vs. being 65+ years old. Additionally, certain comorbidities (including myocardial infarction and multiple myeloma) were associated with higher costs when compared with patients without those (all p<0.05). Determinants for hospitalization included: having severe AL amyloidosis (odds ratio: 3.01, p<0.001), myocardial infarction (2.49, p=0.004), cerebrovascular disease (2.14, p=0.042), chronic pulmonary disease (2.49, p<0.001), connective tissue/rheumatic disease (3.54, p=0.015), mild liver disease (2.25, p=0.017), diabetes with chronic complications (3.43, p=0.001), hypotension (2.30, p=0.002), hepatomegaly (7.05, p<0.001), and purpura (2.84, p<0.001).

CONCLUSIONS: Younger patients and patients with severe AL amyloidosis, as well as associated specific comorbidities, had higher healthcare costs and/or hospitalization. Results from our study may inform policy efforts to contain higher healthcare costs and utilizations for AL amyloidosis patients.