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Article History

Received: 20 May 2025

Accepted: 11 August 2026

First Online: 19 September 2026

Declarations

Conflict of Interest: Shravanthi Gandra is an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, and owns stock/stock options in Merck & Co., Inc., Rahway, NJ, USA. At the time this study was conducted, Mahek Garg was an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, and owned stock/stock options in Merck & Co., Inc., Rahway, NJ, USA. Ambika Satija, Benjamin Meade, Yan Song, and James Signorovitch are employees of Analysis Group, Inc., a consulting company that provided paid consulting services to Merck & Co., Inc., which funded the development and conduct of this study and manuscript.

Ethics Approval: Data were deidentified and comply with the patient requirements of the HIPAA of 1996. No review by an institutional review board was required per Title 45 of CFR, Part 46.101(b)(4) ( ). The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Consent to Participate: Not applicable. Data were deidentified and comply with the patient requirements of the HIPAA of 1996, therefore, consent to participate was not required.

Consent for Publication: Not applicable. Data were deidentified and comply with the patient requirements of the HIPAA of 1996, therefore, consent for publication was not required.

Data Availability Statement: The data that support the findings of this study are available from Optum. Restrictions apply to the availability of these data, which were used under license for this study. Permission to access these data must be requested from Optum ( ).

Code Availability: Not applicable.

Author Contributions: Mahek Garg and Shravanthi Gandra contributed to study conception and design, data analysis, and interpretation. Ambika Satija, Yan Song, and James Signorovitch contributed to study conception and design, collection and assembly of data, data analysis, and interpretation. Benjamin Meade contributed to collection and assembly of data, data analysis, and interpretation. All authors read and approved the final version and agree to be accountable for the work.