Background
Disease-modifying therapies benefit individuals with relapsing forms of
multiple sclerosis, but their utility remains unclear for those without
relapses.
Objective
To determine disease-modifying therapy use and costs in 2009, compare use in
2009 and 2000, and examine compliance with evidence-based guidelines.
Methods
We determined the extent and characteristics of disease-modifying therapy use
by participants in the Sonya Slifka Longitudinal Multiple Sclerosis Study
(Slifka) in 2000 (
n
=2156) and 2009
(
n
=2361) and estimated out-of-pocket and total (payer)
costs for 2009. Two multivariable logistic regressions predicted
disease-modifying therapy use.
Results
Disease-modifying therapy use increased from 55.3% in 2000 to 61.5% in 2009.
In 2009, disease-modifying therapy use was reported by 76.5% of participants
with relapsing-remitting multiple sclerosis, 73.2% with
progressive-relapsing multiple sclerosis, 62.5% with secondary progressive
multiple sclerosis, and 41.8% with primary progressive multiple sclerosis.
Use was significantly associated with relapsing-remitting multiple
sclerosis, shorter duration of illness, one to two relapses per year,
non-ambulatory symptoms, using a cane, younger age, higher family income,
and having health insurance. Average annual costs in 2009 were US$939–3101
for patients and US$16,302–18,928 for payers.
Conclusion
Use rates were highest for individuals with relapsing-remitting multiple
sclerosis, but substantial for those with progressive courses although
clinical trials have not demonstrated significant benefits for them.