Â鶹´«Ã½Ó³»­

Â鶹´«Ã½Ó³»­

Explore the latest content from across our publications
Join The Â鶹´«Ã½Ó³»­

Log In

Forgot Password?
Create New Account

Loading... please wait

Abstract Details

Patterns and Trends of Healthcare Utilization among People with Multiple Sclerosis in the Age of Disease-Modifying Therapy: an Analysis of Administrative Claim Data from a Commercially Insured Population in the United States, 2004-2013
Multiple Sclerosis
P9 - Poster Session 9 (12:00 PM-1:00 PM)
9-002
To compare healthcare expenditure and utilization in multiple sclerosis (MS) across disease-modifying treatments (DMTs).
DMTs contributes to the high cost of MS care. Their role in healthcare expenditure and utilization warrants detailed examination.

We performed retrospective analyses of claim data from a commercially insured MS population (2004-2013). We defined MS cohort entry as the third occurrence of ICD-9 code for MS. We included patients on monotherapy of DMTs: high-efficacy (HE: natalizumab) and standard-efficacy (SE: interferon-beta, glatiramer acetate, fingolimod, dimethyl fumarate and teriflunomide). We ascertained the healthcare expenditure based on insurance claims (USD) over time. We measured the incidence rate of key healthcare utilizations: hospitalizations, emergency visits, doctor visits, neurologist visits, MRI of brain and spinal cord, and steroid infusions. We calculated the incidence rate ratio (IRR) across groups using Poisson regression, with either patients never on any DMT (ND) or patients treated with interferon-beta as reference, adjusting for relevant covariates. 

Our cohort included 31,772 patients (mean age=45 years, 75% women), all with >=3 months of insurance coverage preceding MS cohort entry. Both HE (β=USD32,725.2, p<0.0001) and SE (β=USD4,650.7, p<0.0001) group had significantly higher mean healthcare expenditure than the ND group after cohort entry. Among DMTs, interferon-beta had the lowest mean healthcare expenditure at all time points, whereas natalizumab had the highest at 24 and 36 months. Using ND as reference, all DMTs had significantly lower IRR of doctor visits (0.47-0.69) and hospitalizations (0.09-0.37) during DMT treatment period. Interferon-beta and glatiramer acetate also had significantly lower IRR of MR brain (0.93 and 0.91) and MRI spinal cord (0.76 and 0.81).
This study suggests that DMT costs are potentially the main driver of high healthcare expenditure in MS, and highlights the need for prospective comparative studies towards value-based medicine.
Authors/Disclosures
Wen Zhu
PRESENTER 		No disclosure on file
No disclosure on file
No disclosure on file
Michael Isfort, MD (The Ohio State University Wexner Medical Center, Department of Neurology) Dr. Isfort has nothing to disclose.
No disclosure on file
Tianxi Cai Tianxi Cai has nothing to disclose.
No disclosure on file
Zongqi Xia, MD, PhD The institution of Dr. Xia has received research support from National Institute of Health. The institution of Dr. Xia has received research support from Genentech/Roche.