0703 Impact of Economic Status Across Race and Ethnicity on Narcolepsy Treatment Access: A Claims Database Analysis

Introduction Narcolepsy type 1 (NT1) and type 2 (NT2) affect patients of diverse backgrounds. Methods The Komodo Health claims database was used to identify patients with exactly 1 valid NT1 or NT2 diagnosis (ie, ≥2 relevant ICD-10 codes 30 days apart) prior to 2023 and 100% observable claims in 2023. Multiple separate NT1 or NT2 diagnoses or a single diagnosis with 1 claim in 2023 was exclusionary. Proportions of patients who received gold-standard narcolepsy treatment (ie, 2021 American Academy of Sleep Medicine strong recommendations [modafinil, pitolisant, solriamfetol, sodium oxybate], other oxybates, and armodafinil), oxybate treatment, or no treatments for excessive daytime sleepiness (EDS) in 2023 were calculated by self-reported race and ethnicity, and national income tercile. Results The closed data set included 30,563 patients with a single NT1 or NT2 diagnosis (NT1, 15%; NT2, 85%); of these, 16,389 patients had race and ethnicity data and income data available. Gold-standard narcolepsy treatments were received by 41% of Black/African American, 44% of Hispanic/Latino, and 48% of white patients. Oxybate treatment was received by 5% of Black/African American, 8% of Hispanic/Latino, and 8% of white patients. EDS treatments were not received by 35% of Black/African American, 28% of Hispanic/Latino, or 21% of white patients. The greatest proportions of patients who received gold-standard narcolepsy treatments were in the upper income tercile (lower, middle, upper terciles, respectively: Black/African American, 40%, 44%, 49%; Hispanic/Latino, 41%, 47%, 53%; white, 45%, 50%, 53%). The greatest proportions of patients who received oxybate treatment were in the upper income tercile (lower, middle, upper terciles, respectively: Black/African American, 4%, 7%, 8%; Hispanic/Latino, 7%, 8%, 10%; white, 6%, 7%, 11%). The lowest income tercile had the greatest proportion of patients not receiving EDS treatments (lower, middle, upper terciles, respectively: Black/African American, 39%, 36%, 30%; Hispanic/Latino, 31%, 28%, 22%; white, 23%, 20%, 19%). Conclusion These results reflect disparities in narcolepsy treatment, as patients in racial and ethnic groups consistently did not receive gold-standard treatments, regardless of income level. Support (if any)