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Article History

Accepted: 3 August 2025

First Online: 23 August 2025

Declarations

:

: N.E.N., K.A., and C.L. are employees of Optum. K.J.M. was an employee at Optum at the time of the study. N.E.N., K.J.M., and K.A. are shareholders in UnitedHealth Group. P.M., J.B., T.J., M.W., and C.H. are employees of Gilead Science Inc.

: Institutional review board approval or waiver of approval was not required for this study because the study data were secondary and deidentified in accordance with the United States Department of Health and Human Services Privacy Rule’s requirements for de-identification codified at 45 C.F.R. § 164.514(b).

: Not applicable.

: Throughout the study, patient privacy was preserved, and researchers complied strictly with all applicable Health Insurance Portability and Accountability Act data management rules and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

: The data contained in the Optum database contain proprietary elements owned by Optum, and therefore cannot be broadly disclosed or made publicly available at this time. The disclosure of these data to third-party clients assumes certain data security and privacy protocols are in place and that the third-party client has executed our standard license agreement, which includes restrictive covenants governing the use of the data.

: Code is not able to be provided for this publication.

: Conceptualization and study design was conducted by K.J.M., N.E.N., P.M., J.B., M.W., and C.H. The study methodology was determined by K.J.M., N.E.N., and C.H. Acquisition and analysis of the data were conducted by K.J.M., N.E.N., K.A., and C.L. All authors interpreted the findings. All authors read and approved the final manuscript and reviewed and commented on all previous versions.