Neuromyelitis optica spectrum disorder in Germany: A claims data analysis of incidence, prevalence, treatment patterns, and diagnostic overlap with multiple sclerosis

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Abstract
Background: Neuromyelitis optica spectrum disorders (NMOSD) are rare autoimmune diseases of the central nervous system. Global prevalence estimates vary widely, and data for Germany are limited. Objectives: To estimate NMOSD prevalence, incidence, diagnostic settings, comorbid coding with multiple sclerosis (MS), and treatment patterns in Germany. Methods: We analyzed German BARMER health insurance claims data (approximately 9 million persons; 2015–2022). NMOSD cases were identified by ICD-10-GM code G36.0. Frequencies, diagnostic settings, comorbid MS coding (G35.-), and treatment patterns (Anatomical Therapeutic Chemical codes) were assessed. Results: We identified 527 incident NMOSD cases (0.82 per 100,000 insured persons per year); 69% were female, and 42% aged 40–59 years. Most diagnoses occurred in outpatient care (63%), primarily by neurologists (48%) or general practitioners (28%). Prevalence increased from 2.9 to 4.7 per 100,000 between 2015 and 2022, while NMOSD-specific medication use rose from 16% to 31%. NMOSD and MS codes co-occurred in 64% of cases; 49% had concurrent diagnoses within 9 months, and 42% were first diagnosed with MS. Conclusion: NMOSD prevalence and incidence in Germany are increasing, with frequent diagnostic overlap with MS. Findings highlight the need for improved diagnostic differentiation and early specialist involvement.

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