(134) The Impact of COVID-19 Containment Strictness on the Administration of Romosozumab among Medicare Enrollees in the Most Socioeconomically Vulnerable Counties in the US

Background: Romosozumab (romo) is an injectable osteoporosis (OP) medicine for women with postmenopausal osteoporosis at high risk of fracture, approved by FDA in April 2019. The shift to remote care during the COVID-19 pandemic raised questions about romo utilization and disparities in administration.

Objectives: Evaluate the impact of COVID lockdown on romo administrations among users in socioeconomically vulnerable US counties.

Methods: Using Medicare fee-for-service data from 2019-4-1 to 2020-12-31, all romo administrations were identified and aggregated weekly at the corresponding area level of analysis. County FIPS codes of patients’ residence were mapped with county-level social vulnerability index (SVI) socioeconomic (SES) theme. As the nationwide COVID emergency was declared on Mar. 13, 2020, the period after Mar. 15, 2020 was designated as the post-COVID-lockdown period.
The strictness of lockdown at state level is based on the stringency index from Oxford COVID-19 Government Response Tracker (OxCGRT). We calculated the proportion of days covered at stringency index > 60 during year 2020 for each state and categorized the states as Lenient, Rigorous, or More rigorous based on the tertile of the proportion.
Interrupted time series design was used to evaluate the change of romo administration at the time of lockdown and trend change before and after the lockdown. Primary analysis was performed in the romo users from counties with the highest quartiles (most vulnerable) of SES theme. Stratified analysis then were performed based on the lockdown strictness for the highest quartile of SES theme.

Results: The study included 13,836 romo users, contributing 84,129 administrations, among which 26,267 from highest SES quartile counties. At the time of lockdown, romo administration significantly dropped
(-83.4/week, p< 0.001). During lockdown, weekly administration decreased by 5.6/week (p=0.22). However, stratified analysis revealed significant changes at the time of lockdown (-23.6/week, -30.3/week, -29.1/week for Lenient, Rigorous, More Rigorous, respectively; p< 0.05), with post-lockdown trend changing only in the More Rigorous category (-1.3/week, p< 0.01).

Conclusions: A decline in romo administration during COVID among Medicare beneficiaries were found particularly in socioeconomically vulnerable areas. Healthcare providers should pay special attention to patients residing in these communities. The decrease in trend of romo administration during lockdown in states with more rigorous containment approaches necessitates the timely assistance and minimizing contact for in-person provider-administered therapy when access is compromised.