Abstract
BackgroundFor patients with multiple sclerosis (MS), previous research identified key disease sequelae as important cost drivers and suggested that among users of disease-modifying drugs (DMDs) in 2004, DMDs represented 73% of the total cost of care. More recent studies were limited to incident disease/treatment and/or excluded DMDs from cost estimates. To support contemporary pharmacoeconomic analyses, the present study was conducted to provide updated information about MS-related costs and cost drivers including DMDs.MethodsFor each of 2 years, 2006 and 2011, commercially insured, continuously eligible patients with ≥ 1 medical claim diagnosis of MS were sampled. MS-related charges were based on medical claims with MS diagnosis plus medical/pharmacy claims for DMDs. 2006 charges were adjusted to 2011 $ using the medical care component of the consumer price index (CPI). Subgroups of patients using DMDs (interferon [IFN] beta-1a intramuscular or subcutaneous, IFN beta-1b, glatiramer, natalizumab) in 2011 were identified. By-group differences were tested with bivariate statistics.ResultsMean (standard deviation [SD]) age of 15,902 sample patients in 2011 was 47.6 (11.8) years, 76% female. Mean [SD] MS charges ($26,520 [$38,478] overall) were significantly (P < 0.001) higher for patients with common disease sequelae: malaise/fatigue (n = 2,235; $39,948 [$48,435]), paresthesia (n = 1,566; $33,648 [$45,273]), depression (n = 1,255; $42,831 [$51,693]), and abnormality of gait (n = 1,196; $48,361 [$55,472]). From 2006 to 2011, CPI-adjusted MS charges increased by 60%. Among patients treated with a single DMD in 2011, inpatient care was 6% of charges (range = 4%-8%; P = 0.155); outpatient care was 19% (range = 14%-20% except for natalizumab [29%]; P < 0.001); and DMDs were 75% (range = 67%-81%; P < 0.001).ConclusionsCommon MS sequelae remain important cost drivers. Although MS treatment costs are increasing, the proportion of MS charges due to DMDs in 2011 is similar to that reported in 2004.
Highlights
For patients with multiple sclerosis (MS), previous research identified key disease sequelae as important cost drivers and suggested that among users of disease-modifying drugs (DMDs) in 2004, DMDs represented 73% of the total cost of care
In 2002, a joint task force of the American Academy of Neurology and MS Council for Clinical Practice Guidelines recommended that IFN beta treatment be considered “in any patient who is at high risk for developing [clinically definite MS (CDMS)], or who already has either relapsing-remitting MS (RRMS) or secondary progressive MS (SPMS) and is still experiencing relapses” and that treatment with glatiramer be considered for patients with RRMS [6]
A 2008 disease management consensus statement from the National Multiple Sclerosis Society indicated that treatment with an IFN beta medication or glatiramer “should be considered as soon as possible following a definite diagnosis of MS with active, relapsing disease, and may be considered for selected patients with a first attack who are at high risk of MS” [7]
Summary
For patients with multiple sclerosis (MS), previous research identified key disease sequelae as important cost drivers and suggested that among users of disease-modifying drugs (DMDs) in 2004, DMDs represented 73% of the total cost of care. A 2008 disease management consensus statement from the National Multiple Sclerosis Society indicated that treatment with an IFN beta medication or glatiramer “should be considered as soon as possible following a definite diagnosis of MS with active, relapsing disease, and may be considered for selected patients with a first attack who are at high risk of MS” [7]. DMDs are high-cost medications, with one economic analysis estimating total treatment expense including laboratory monitoring costs at $2,294 to $2,461 per month (2008 U.S.$) [8] Because both direct medical care costs and societal costs (e.g., payments for disability and sick leave, value of caregiver time) increase as the disease advances [9], the efficacy of DMDs in slowing the progression of MS has the potential to offset drug acquisition costs with savings on other resources
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