Abstract
BackgroundIn this study, we aimed to understand the trends in total and itemized medical expenses, especially of disease-modifying therapy (DMT), for multiple sclerosis (MS) in Japan through an analysis of health insurance claims data.MethodsWe analyzed a database containing health insurance claims data from hospitals that have adopted the Diagnosis Procedure Combination/Per-Diem Payment System in Japan. According to an algorithm based on diagnosis codes, data for all patients diagnosed with MS from April 2008 to July 2016 were extracted. Medical costs, rate of each medical treatment, and rate of relapses were analyzed by calendar-year. Medical costs in the month of relapse were compared with average medical costs per month of all MS patients by a cross-sectional analysis.ResultsFour thousand three hundred seventy-four MS patients were identified in the database. Total medical cost per patient per month (PPPM) increased from ¥87,640 (US$787.7 or €723.0 as of May 2017) to ¥102,846 (US$924.4 or €848.4) during the study period. This increment was mainly attributed to the growth in cost of outpatient DMT prescriptions, which increased from ¥23,039 (US$207.1 or €190.1) to ¥51,351 (US$461.5 or €423.6). In contrast, the rate of hospitalizations and relapses PPPM decreased during the study period (from 0.053 to 0.030, and 0.032 to 0.019, respectively). Medical costs in the month of relapse (¥424,661, US$3816.8 or €3503.1) were 3.57 times higher than the average monthly costs for all MS patients (¥119,021, US$1069.8 or €981.8), with the majority comprising hospitalization cost.ConclusionConcomitant with the increased usage of DMT, the total medical cost for treating MS is increasing in Japan. However, rates of relapse and hospitalization have shown a decreasing trend. Although this study does not show the direct causality between DMT and reduction of relapse rates/fewer hospitalizations among MS patients, a reduction in hospital costs has been revealed concomitantly with the increasing prevalence of DMT.
Highlights
In this study, we aimed to understand the trends in total and itemized medical expenses, especially of disease-modifying therapy (DMT), for multiple sclerosis (MS) in Japan through an analysis of health insurance claims data
Our data did not reveal a direct causality between DMT and reduction of the relapse rate, it is demonstrated that disease progression in MS has decelerated, with longer time in remission correlated with the prevalence of DMT use
Based on real-world data analysis, we revealed that DMT cost has grown rapidly in recent years, leading to an increase of total medical cost for MS in Japan
Summary
We aimed to understand the trends in total and itemized medical expenses, especially of disease-modifying therapy (DMT), for multiple sclerosis (MS) in Japan through an analysis of health insurance claims data. In recent years, diseasemodifying therapy (DMT) has been commonly used to prevent relapse in a certain type of MS—relapsing–remitting multiple sclerosis [4, 5]. In the United States, 12 DMT drugs are currently available. The cost of DMT has almost doubled from 2008 to 2012 in the United States, with a 5 to 7 times higher rate of annual increase compared to that of other prescription drugs [7]. The average cost of DMT per patient per month (PPPM) in 2013 was approximately $2400, comprising more than 60% of the total medical cost for MS [8]. The cost of DMT imposes significant economic burden on healthcare systems in the United States [9]
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