The American Academy of Neurology's Top Five Choosing Wisely recommendations

Langer‐Gould, Annette; Anderson, W.; Armstrong, Melissa J.; Cohen, Adam B.; Eccher, Matthew; Iverson, D. J.; Potrebic, Sonja; Becker, Amanda; Larson, R.E.; Gedan, Alicia; Getchius, Thomas S.D.; Gronseth, Gary S.

doi:10.1212/wnl.0b013e3182a69c98

Cited by 37 publications

(2 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other MS experts responded that this was ‘an oversimplified recommendation’ because ‘progressive patients who are on one of these agents and having no relapses are likely obtaining a partial treatment benefit and should remain on the agent’. 29 Implicit in this statement are two arguments. First, the ‘absence of evidence is not evidence of absence', 30 i.e., lacking evidence of benefit does not mean there is no benefit, simply that more research is needed.…”

Section: Discussionmentioning

confidence: 99%

Use and cost of disease-modifying therapies by Sonya Slifka Study participants: has anything really changed since 2000 and 2009?

Minden

Kinkel

Machado

et al. 2019

Multiple Sclerosis Journal - Experimental, Translational and Cl

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Use and cost of disease-modifying therapies by Sonya Slifka Study participants: has anything really changed since 2000 and 2009?

Minden

Kinkel

Machado

et al. 2019

Multiple Sclerosis Journal - Experimental, Translational and Cl

View full text Add to dashboard Cite

show abstract

“…Many in the MS community thought that this broad recommendation failed to consider the nuances of which patients with MS might benefit from continued use of DMTs. 4 An alternative, more prescriptive approach to cost containment is to introduce new strategies for managing MS that are medically and economically sound. We outline here 5 possible strategies, but many others could be proposed as well.…”

mentioning

confidence: 99%

Reducing costs while enhancing quality of care in MS

Kister

Corboy

2016

Neurology

View full text Add to dashboard Cite

The rapid escalation in prices of disease-modifying therapies (DMTs) for multiple sclerosis (MS) over the past decade has resulted in a dramatic overall increase in the costs of MS-related care. In this article, we outline various approaches whereby neurologists can contribute to responsible cost containment while maintaining, and even enhancing, the quality of MS care. The premise of the article is that clinicians are uniquely positioned to introduce innovative management strategies that are both medically sound and cost-efficient. We describe our "top 5" recommendations, including strategies for customizing relapse treatment; developing alternative dosing schedules for Food and Drug Administration-approved MS DMTs; using off-label therapies for relapse suppression; and limiting the use of DMTs to those who clearly fulfill diagnostic criteria, and who might benefit from continued use over time. These suggestions are well-grounded in the literature and our personal experience, but are not always supported with rigorous Class I evidence as yet. We advocate for neurologists to take a greater role in shaping clinical research agendas and helping to establish cost-effective approaches on a firm empiric basis. Neurology ® 2016;87:1617-1622 GLOSSARY DMT 5 disease-modifying therapy; FDA 5 Food and Drug Administration; MS 5 multiple sclerosis; PML 5 progressive multifocal leukoencephalopathy; UBO 5 unidentified bright object.

show abstract