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Abstract Rationale Amikacin liposome inhalation suspension (ALIS), as part of a combination antibacterial regimen, is currently the only FDA-approved treatment for patients with refractory Mycobacterium avium complex lung disease (rMACLD). MAC is the most common cause of nontuberculous mycobacterial lung disease (NTMLD). A real-world evidence study demonstrated significant decreases in hospitalizations from baseline over a 12-month follow-up period following ALIS initiation; however, study conclusions were limited by the absence of a comparator arm. In this study, we compared healthcare resource utilization in US patients who initiated ALIS versus non-ALIS antibiotic treatment for possible rMACLD. Methods This was a retrospective claims analysis using the Merative™ MarketScan® databases between 2016 and 2021. As no diagnosis codes for MACLD exist in claims, we defined 2 cohorts of patients receiving treatment for possible rMACLD as follows: 1) patients who initiated ≥28 days of continuous treatment with ALIS; and 2) patients who initiated ≥28 days of continuous treatment with ≥1 non-ALIS antibiotic used to treat rMACLD (i.e., parenteral aminoglycoside, clofazimine, fluoroquinolones, linezolid, tedizolid, or bedaquiline) ≥6 months after initiating treatment used for MACLD (i.e., with a combination of ≥2 antibiotics from a macrolide, ethambutol, and a rifamycin). The date of initiating treatment with ALIS or non-ALIS antibiotic for rMACLD was referred to as the index date. Other inclusion criteria: ≥1 diagnosis code for NTMLD anytime pre-index, ≥6 months continuous eligibility pre-index, and ≥12 months continuous eligibility post-index. Hospitalizations (all-cause, respiratory-related, NTMLD-related) and emergency room (ER) visits at 0-6 and 7-12 month post-index periods were compared with baseline (6 month pre-index period) per treatment arm. Results A total of 116 patients comprised the ALIS cohort and 63 patients the non-ALIS cohort. In the ALIS cohort, statistically significant reductions from baseline in all-cause, respiratory-related, and NTMLD-related hospitalizations were observed during the 7-12 month post-index period (Table). In contrast, the non-ALIS cohort did not show significant reductions from baseline in hospitalizations at follow-up. No statistically significant changes from baseline in ER visits were observed in either group. Conclusions Patients treated with ALIS for rMACLD had statistically significant reductions in hospitalizations from baseline during the 7-12 month post-index period, whereas no statistically significant improvements in hospitalizations were observed in the non-ALIS antibiotics group.