Introduction Despite the increasing age of the multiple sclerosis (MS) patient population, data are lacking on MS patients in later life. This retrospective study investigated treatment patterns, healthcare resource utilization (HCRU), and healthcare costs (HCCs) for patients enrolled in Medicare, in relation to disease-modifying therapy (DMT) and corticosteroid treatment as a marker for relapse. Methods Medical and pharmacy claims between January 1, 2010 and July 31, 2015 identified MS patients. The anchor date was defined as the most recent MS claim. Analyses were performed on claims in the 12-month baseline period before the anchor date. Outcomes were stratified by DMT use and number (0, 1, or ≥ 2) of corticosteroid treatments. Results Among Medicare MS patients ( n = 7072; mean age 57 years), 66% received DMT during the baseline period; 31% had 1 claim and 16% had ≥ 2 claims for corticosteroids. Compared with patients not receiving DMT, patients on DMT were less likely to receive corticosteroids (39% vs 62%) and had fewer all-cause hospitalization episodes and ER visits. DMT use was associated with lower HCRU but higher HCCs in patients both with and without corticosteroid treatment. DMT switching rates were low, both among patients with no corticosteroid (5.6%) and patients with 1 (9.3%) or ≥ 2 (11.1%) corticosteroid treatments. DMT switches were most frequently from an injectable to an oral therapy. Conclusion In Medicare patients with MS, DMT use was associated with higher HCCs but lower HCRU, indicative of better health outcomes; however, low DMT switching rates may be an indicator of possible clinical inertia. Funding Sanofi. Plain Language Summary Plain language summary available for this article. Electronic supplementary material The online version of this article (10.1007/s40120-018-0123-y) contains supplementary material, which is available to authorized users.

received DMT. Patients with DMT were less likely to have a corticosteroid claim than patients not receiving DMT (39% vs 62%), and less likely to have an ER visit (39% vs 54%) or hospitalization episode (18% vs 29%).

A 3 4 7 -A 7 6 6 A629 the impact of increased HCBS investment on elderly Medicaid beneficiaries' care pathways. In this paper, we explore the impact of state Medicaid HCBS investment on the elderly beneficiaries' risks of nursing home admission using four waves of the Health and Retirement Study (2006-2013). Methods: We use a simulated instrument of Medicaid eligibility that depends only on the state's eligibility rules. We draw a random sample of 5,000 observations from our sample at wave 10 (2010-2011), and calculate the fraction of elders who would be eligible for Medicaid HCBS in each state. We then instrument the actual eligibility variable with that simulated instrument. Results: We find that Medicaid eligibility significantly increases higher risk of nursing home admission (1% level). On average, an increase in the Medicaid generosity for HCBS reduces the effect of Medicaid eligibility on the use of nursing homes. For a $1 increase in Medicaid per-capita spending towards HCBS, the average reduction in the predicted conditional probability of nursing home admission is 0.002 percentage points. ConClusions: Our results support the idea that investing in HCBS can lead to long-term cost savings, which is useful in the perspective of framing a Federal-level strategy to develop a high performing system of LTSS for elderly people.objeCtives: Evidence-based and successful policy requires making investment decisions -on all level of health care investments -should be based on objective and verifiable methods. Health technology assessment (HTA) plays an important role in evidence-based decision-making and by the help of HTA optimal health outcomes and efficient use of available resources could be achieved. Methods: A literature review was conducted to define the number of health care investments that was introduced to Hungary between 2010 and 2015 and real, independent HTA Department managed assessments were introduced with validated methods to define the effects of investments on long-term from policy point of view. The aim of the literature review was also to show the opportunities of the involvement of HTA Department, Hungary into the coming EU or member state financed projects e.g. in primary care, screening or public health programs to avoid developing diabetes and the need for expensive interventions. Results: According to the literature review the role of HTA is more and more important in all level of decision making. Despite the investment decision making and assessment of programs are not based on HTA. The Hungarian HTA Department was not involved into any program assessment till the end of 2015 when the Health Services Management Training Centre (HSMTC) of Semmelweis University initiated a cooperation aiming the HTA of diabetes, hypertension and smoking interventions of the Public Health focused Primary Care Model Program of the Swiss-Hungarian Cooperation. ConClusions: More transparency in EU financed health-care related programs ensure an unbiased decision-making process. By the help of the HTA Department...