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Background: To evaluate healthcare utilization and cost barrier patterns among childhood cancer survivors (CCS) compared with noncancer controls.

Introduction Although short-term clinical trials have demonstrated that switching from infliximab (INF) bio-originator to its biosimilar is safe with no significant loss of efficacy, there are limited real-world data comparing their patterns of use and adherence. Methods Using 2015–2018 IBM Marketscan data, we established 4 cohorts of patients with at least one administration or pharmacy claim for INF bio-originator or biosimilar in 2017, including INF naïve biosimilar users, INF prevalent biosimilar users, INF naïve bio-originator users, and INF prevalent bio-originator users, defined according to their prior use of INF from 2015 to their first INF administration in 2017. The proportion of days covered (PDC) was calculated for patients with at least 6, 12, or 18 months of follow-up time. Factors associated with optimal adherence (PDC > 80%) were evaluated using log-binomial models. Results We identified 96 INF naïve biosimilar users, 223 INF prevalent biosimilar users, 2,149 INF naïve bio-originator users, and 10,970 INF prevalent bio-originator users. At the end of 18 months of follow-up, 64% of INF prevalent bio-originators, 48% of INF naïve biosimilars, 41% of INF naïve bio-originators, and 36% of INF prevalent biosimilars had optimal adherence. Depression, previous hospitalization, and greater use of prior biologics were negatively associated with adherence, whereas IBD diagnoses (referent to RA) and age 55–64 (referent to < 35) were positively associated with high adherence. Conclusion INF prevalent users had higher adherence in our analyses than INF naïve users. However, further studies with larger sample size are needed to evaluate INF biosimilar users’ adherence.

Background: Most adults with hypertension have other chronic conditions. As obesity and diabetes are increasing among US adults, the prevalence of multimorbidity may have increased among US adults with hypertension. Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) to assess the trend in multimorbidity among US adults (ages ≥ 20 years) with (n = 24,646) and without (n = 24,189) hypertension from 1999-2000 through 2017-March 2020. Hypertension was defined as systolic blood pressure ≥130 mm Hg, diastolic blood pressure ≥80 mm Hg, or use of antihypertensive medication. Multimorbidity was defined as the co-occurrence of ≥ 3 chronic conditions, not including hypertension. Chronic conditions were selected based on a framework from a US Health and Human Services report and data available in NHANES and included dyslipidemia, coronary heart disease, stroke, heart failure, diabetes, obesity, liver fibrosis, chronic kidney disease, asthma, lung disease (chronic obstructive pulmonary disease, emphysema, or chronic bronchitis), arthritis, hepatitis-C, cancer, and depression. Results: From 1999-2000 to 2017-2020, the age-adjusted mean number of chronic conditions increased from 2.4 to 3.0 among US adults with hypertension and from 1.9 to 2.2 among US adults without hypertension (Figure, top panel). During this period, the age-adjusted prevalence of multimorbidity increased from 42% to 56% among US adults with hypertension and from 32% to 34% among US adults without hypertension (Figure, bottom panel). In 2017-2020, after age, race/ethnicity, and sex adjustment, the mean difference in the number of chronic conditions among US adults with versus without hypertension was 0.70 (95% CI: 0.56 - 0.84). Multimorbidity was 1.50 (95% CI: 1.34 - 1.68) times more common among US adults with versus without hypertension. Conclusion: Multimorbidity has increased among US adults, and its prevalence is higher among adults with versus without hypertension.

Objective In March and April 2020, medical societies published statements recommending continued use of renin-angiotensin-system (RAS) inhibitors despite theoretical concerns that these medications could increase COVID-19 severity. Determining if patients discontinued RAS inhibitors during the COVID-19 pandemic could inform responses to future public health emergencies. Methods We analyzed claims data from US adults with health insurance in the Marketscan database. We identified patients who filled a RAS inhibitor and were persistent, defined by not having a ≥30-day gap without medication available, and high adherence, defined by having medication available on ≥80% of days, from March 2019 to February 2020. Among these patients, we estimated the proportion who discontinued their RAS inhibitor (i.e., had ≥30 consecutive days without a RAS inhibitor available to take) between March and August 2020. For comparison, we estimated the proportion of patients that discontinued a RAS inhibitor between March and August 2019 after being persistent with high adherence from March 2018 to February 2019. Results Among 816,380 adults who were persistent and adherent to a RAS inhibitor from March 2019 to February 2020, 10.8% discontinued this medication between March and August 2020. Among 822,873 adults who were persistent and adherent to a RAS inhibitor from March 2018 to February 2019, 11.7% discontinued this medication between March and August 2019. The multivariable-adjusted relative risk for RAS inhibitor discontinuation in 2020 versus 2019 was 0.94 (95%CI 0.93-0.95). Conclusion There was no evidence of an increase in RAS inhibitor discontinuation during the early stage of the COVID-19 pandemic.