Patterns of Utilization and Expenditure Across Multiple Sclerosis Disease-Modifying Therapies: A Retrospective Cohort Study Using Claims Data from a Commercially Insured Population in the United States, 2010–2019

Abstract

Introduction Comparisons of healthcare utilization and expenditure among multiple sclerosis (MS) disease-modifying therapies (DMTs) are limited. Methods In this retrospective cohort study using commercial insurance claims data of a US population (2010–2019), we compared healthcare utilization and costs in MS across different DMTs. We assigned patients to different treatment arms: no DMT (ND), high-efficacy (HE) DMT (alemtuzumab, B cell depletion, cladribine, and natalizumab), and standard-efficacy (SE) DMT (dimethyl fumarate, glatiramer acetate, interferon beta, sphingosine-1-phosphate receptor modulator, and teriflunomide). We obtained healthcare costs and occurrences of healthcare services: outpatient visits, emergency room visits, hospitalizations, MS-related magnetic resonance imaging (MRI). We quantified relapses (based on MS-related hospitalizations, as well as outpatient visits with prescription of high-dose steroids) and medical complexity (based on unique drug classes of prescriptions). We calculated covariate-adjusted incidence rate ratio of healthcare services using negative binomial regression with ND as reference and covariate-adjusted mean cumulative healthcare costs using a generalized linear model with log-link function and gamma distribution. Results Among the 25,932 patients with MS (mean age 52.8 years, 75.2% women), both HE (mean age 54.0 years, 76.2% women) and SE (mean age 43.9 years, 75.6% women) groups had more non-pharmacy healthcare utilization than ND (mean age 57.6 years, 75.4% women), including overall outpatient doctor visits, neurology visits, and MS-related MRIs as well as relapses and medical complexities. Relative to ND, both HE and SE groups had higher pharmacy costs and overall healthcare costs 12 months after treatment initiation, despite having lower or equivalent non-pharmacy medical costs. In patients on DMT, pharmacy costs accounted for up to 65% of overall healthcare costs with over 85% of pharmacy costs attributable to DMT costs. Conclusion DMT cost is a key driver of the overall healthcare expenditure in MS. Future comparative and cost-effectiveness studies integrating claims and electronic health records data with better balancing of patient characteristics are warranted. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-022-00358-4.

The impact of socioeconomic status on subsequent neurological outcomes in multiple sclerosis

“…This need is particularly urgent in chronic neurological diseases such as multiple sclerosis (MS) given their disproportionally high socioeconomic burden (Fattore et al, 2012;Hartung, 2021;Jennum et al, 2012;Zhu et al, 2022) and modifiable disease course (Giovannoni, 2018;Goldschmidt and McGinley, 2020). Low SES or proxy measures of SES in people with MS (pwMS) is associated with increased risk of MS (Bjørnevik et al, 2016a;Briggs et al, 2015Briggs et al, , 2014Dobson et al, 2020), worsening disability (Briggs et al, 2019;Calocer et al, 2020;D'hooghe et al, 2016;Harding et al, 2019), decreased access to neurological care (Contentti et al, 2019;Minden et al, 2008;Moss et al, 2020;Roddam et al, 2019), and lower quality of life (Boogar et al, 2018;Wang et al, 2020).…”

Association between Serum Biomarker Profile and Real-World Evidence of Disability in Multiple Sclerosis

“…3,4 The available MS disease-modifying therapies (DMTs) pose soaring costs and exhibit variable real-world effectiveness in preventing inflammatory disease activity and delaying disability worsening. [5][6][7] In the current practice, clinicians primarily rely on history, exams and neuroimaging to assess MS disease activity, disability progression, and treatment response. There is an unmet need to improve disease monitoring at the point of care to guide individualized management.…”

Patterns of multiple sclerosis presentation to the emergency department

“…High utilization of DMTs in our population could be due to the fact that access to healthcare and medications in Saudi Arabia is for free and does not apply any restrictions, whereas the annual cost for DMTs in pwMS in the US exceeds 70,000$ (12). Zhu et al (11) also found that patients on HE or ME DMTs had more relapses than those left untreated. There are conflicting reports in literature as it pertains to the effect of DMT on ED visits; One study in British Columbia, Canada, investigated the use of DMT and its relation to the frequency of visits to the ED and found similar numbers on both arms of comparison as 58.0% of DMT users visited the ED whereas 55.6% of DMTs non-users visited the ED (9).…”

“…Using commercial insurance and Medicare Advantage claims, Zhu et al (11) conducted a US study which included 25,932 pwMS and found that 48.9% of patients were on a DMT. In contrast, 84.3% of our patients were on a DMT.…”