Resource utilization, costs and treatment patterns of switching and discontinuing treatment of MS patients with high relapse activity

Abstract

BackgroundMultiple sclerosis (MS) is a chronic disease that affects mainly adults in the prime of their lives. However, few studies report the impact of high annual relapse rates on outcomes. The purpose of this study was to identify high relapse activity (HRA) in patients with MS, comparing differences in outcomes between patients with and without HRA.MethodsA retrospective longitudinal study was conducted using the MarketScan® Commercial Claims and Encounters and Medicare Supplemental Database. Patients had to have at least one ICD-9 for MS (340.XX) in 2009 and one in 2008, be older than 18 years, and have continuous enrolment in the years 2009–2010. HRA was defined as having ≥2 relapses in 2009. Multivariate analyses compared all-cause and MS-specific emergency room (ER) visits, hospitalizations, and all-cause costs, excluding disease modifying therapy (DMT) costs, in 2010 between patients with and without HRA, controlling for baseline characteristics. A subgroup analysis using treatment exposure was also performed.Results19,219 patients were included: 5.3% (n=1,017) had ≥2 relapses in 2009. Patients with HRA were more likely to have all-cause and MS-specific resource utilization than patients without HRA. Mean total all-cause non DMT costs were $12,057 higher for the HRA group. In the subgroup analysis, HRA treatment-naïve patients were more likely to start treatment, and HRA treatment-experienced patients were more likely to discontinue or switch index DMT (P<0.01).ConclusionsPatients with ≥2 relapses annually have higher resource utilization and costs. The difference in cost was over twice as large in treatment-naïve patients versus treatment-experienced patients. HRA was also associated with an increased likelihood of starting DMT treatment (treatment-naïve patients), and switching or discontinuing DMT therapy (treatment-experienced patients).

Healthcare Costs for Treating Relapsing Multiple Sclerosis and the Risk of Progression: A Retrospective Italian Cohort Study from 2001 to 2015

“…Accordingly, previous studies showed that financial consequences of relapses depended not only on the temporary loss of productivity, but also on the subsequent change of treatment [35–37]. Indeed, overall annual healthcare costs, although not being associated with the risk of the first relapse, were positively correlated to the ARR.…”

Switching costs in medical education

“…But decisions to change inevitably involve cost in themselves-these are called switching costs (or sometimes switching barriers). Switching costs are not unique to medical education -they occur in all walks of life[5]. If switching costs are too high, they can cancel out any savings made as a result of going with a lower cost purchase.…”

Increased Relapse Activity for Multiple Sclerosis Natalizumab Users Who Become Nonpersistent: A Retrospective Study

“…Of those that switched or discontinued, significantly higher health care utilization occurred during the 18-month follow-up period compared with those who were persistent on their original index drugs. Raimundo et al (2013) conducted a subgroup analysis on switchers and discontinuers and found that high relapse activity predicts switching or discontinuing from DMTs among MS patients who had used a DMT previously. 38 Our study adds to this research by correlating changes in persistence status with relapse outcomes for natalizumab specifically.…”

“…23,38 used PharMetrics PatientCentric Database to analyze health care resource utilization during an 18-month period after discontinuation or switch from an IFN or GA. 23 The authors found that about half of patients remained on their index drugs. Of those that switched or discontinued, significantly higher health care utilization occurred during the 18-month follow-up period compared with those who were persistent on their original index drugs.…”