Characterizing demographics, comorbidities, and costs of care among populations with Duchenne muscular dystrophy with Medicaid and commercial coverage

Abstract

BACKGROUND: Duchenne muscular dystrophy (DMD) is a severe X-linked progressive neurodegenerative disease characterized by loss of ambulation, cardiomyopathy, respiratory insufficiency, and early mortality. Few data are available that describe the direct medical costs among patients with DMD in the United States. OBJECTIVE: To characterize the demographics, comorbidity burden, and direct monthly costs of care among patients with DMD with Medicaid and with commercial insurance coverage. METHODS: IBM MarketScan Commercial and Multi-State Medicaid claims (2013-2018) were used to identify males aged 30 years or under with diagnostic codes for muscular dystrophy or DMD; additional exclusion criteria were applied to identify those with probable DMD. Baseline characteristics and comorbidities were tabulated. The frequency of health care resource use and median (interquartile range [IQR]) monthly costs (in 2018 USD) were estimated from those with at least 12 months of continuous follow-up. RESULTS: Median (IQR) baseline ages were similar between the Medicaid (14 [9-20] years; n = 2,007) and commercial (15 [9-21] years; n = 1,964) DMD cohorts. The frequency of comorbidities over the period was slightly higher with those on Medicaid. The median duration of follow-up was 3.1 years among members of the Medicaid DMD cohort and 1.7 years among the commercial DMD cohort. Median monthly resource use was generally higher among the Medicaid DMD

Characterizing the Occurrence of Key Clinical Milestones in Duchenne Muscular Dystrophy in the United States Using Real-World Data

“…This study was a US-based, real-world, retrospective cohort study to describe the clinical course of patients with DMD, treated under commercial health insurance plans. The study cohort and entry criteria were described previously in a study examining the characteristics of and economic burden among those with DMD in the US [ 22 ].…”

“…To describe the study sample, consistent with the previous analyses, [ 22 ] the demographic characteristics were summarized, and median duration of follow-up estimated. Health status over the follow-up period was summarized by the percentage observed with at least one prescription for corticosteroids; comorbidity burden (using the median with interquartile range [IQR] Elixhauser Index score, [ 33 ] and the frequency of individual Elixhauser comorbidities); and the prevalence of other key comorbidities of interest.…”

Health Care Use of Cardiac Specialty Care in Children With Muscular Dystrophy in the United States

“…The MarketScan Research Databases have been effectively used in a variety of other studies to characterize patient populations with chronic disease, such as Fontan physiology, HIV, and cirrhosis, and to describe trends in resource use. 20 , 21 , 22 , 23…”

Characteristics of Patients Receiving Novel Muscular Dystrophy Drugs in Trials vs Routine Care

“…Thus, we sought to evaluate the demographic and disease characteristics of patients who initiated novel DMD treatments in routine care in different insured populations and compare them with the patients enrolled in the drugs’ pivotal trials. Previous research has found similarities in demographic characteristics and medical costs between patients with DMD and commercial insurance and those with Medicaid coverage, but differences in relation to the costly new medications have not been studied …”

“…Previous research has found similarities in demographic characteristics and medical costs between patients with DMD and commercial insurance and those with Medicaid coverage, but differences in relation to the costly new medications have not been studied. 13 …”