Persistence, adherence, healthcare resource utilisation and costs for interferon Beta in multiple sclerosis: a population-based study in the Campania region (southern Italy)

Marcello Moccia,Antonio Capacchione,Antonio Carotenuto,Raffaele Palladino,Maria Triassi,Roberta Lanzillo,Vincenzo Brescia Morra,Ilaria Loperto

doi:10.1186/s12913-020-05664-x

Abstract

BackgroundTo differentiate five formulations of Interferon Beta for the treatment of multiple sclerosis (MS) in clinical practice, by analysing persistence, adherence, healthcare resource utilisation and costs at population level.MethodsIn this population-based study, we included individuals with MS living in the Campania Region of Italy from 2015 to 2017, on treatment with intramuscular Interferon Beta-1a (Avonex® = 618), subcutaneous pegylated Interferon Beta-1a (Plegridy® = 259), subcutaneous Interferon Beta-1a (Rebif® = 1220), and subcutaneous Interferon Beta-1b (Betaferon® = 348; and Extavia® = 69). We recorded healthcare resource utilisation from administrative databases (hospital discharges, drug prescriptions, MS-related outpatients), and derived costs from the Regional formulary. We classified hospital admissions into MS-related and non-MS-related. Persistence (time to switch to other disease modifying treatments (DMTs)), and adherence (medication possession ratio (MPR) = medication supply obtained/medication supply expected during follow-up period) were calculated.ResultsPatients treated with Rebif® were younger, when compared with other Interferon Beta formulations (p < 0.01). The probability of switching to other DMTs was 60% higher for Betaferon®, 90% higher for Extavia®, and 110% higher for Plegridy®, when compared with Rebif® (p < 0.01). Plegridy® presented with 7% higher adherence (p < 0.01), and Betaferon® with 3% lower adherence (p = 0.03), when compared with Rebif®. The probability of MS-related hospital admissions was 40% higher in Avonex® (p = 0.03), 400% higher in Betaferon® (p < 0.01), and 60% higher in Plegridy® (p = 0.04), resulting into higher non-DMT-related costs, when compared with Rebif®.DiscussionInterferon Beta formulations presented with different prescription patterns, persistence, adherence, healthcare resource utilisation and costs, with Rebif® being used in younger patients and with less MS-related hospital admissions.

Highlights

To differentiate five formulations of Interferon Beta for the treatment of multiple sclerosis (MS) in clinical practice, by analysing persistence, adherence, healthcare resource utilisation and costs at population level
Among Disease modifying treatment (DMT), there are five preparations of Interferon Beta, which are different in terms of dosing and administration, but are difficult to characterise in clinical practice, with few studies performing direct comparison [1, 3]
During the study period (2015–2017), among 5362 individuals with MS living in the Campania Region, we included 2171 individuals (40.4%) who received at least one Interferon Beta prescription, which resulted into 2514 individual treatment periods

Summary

Introduction

To differentiate five formulations of Interferon Beta for the treatment of multiple sclerosis (MS) in clinical practice, by analysing persistence, adherence, healthcare resource utilisation and costs at population level. In clinical registries, there are potential risks from patient selection (e.g., inclusion of patients and clinical variables only from participating centres), and follow-up (e.g., variable follow-up duration, with patients doing poorly being most likely to be lost to follow-up) [11, 12] Not least, both RCTs and clinical registries do not include healthcare resource utilisation and, more in general, the complexity of MS management [3, 13, 14]

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