Adherence to disease-modifying therapies and its impact on relapse, health resource utilization, and costs among patients with multiple sclerosis

Abstract

Purpose To evaluate adherence to disease-modifying therapies (DMTs) among patients with multiple sclerosis (MS) initiating oral and injectable DMTs, and to estimate the impact of adherence on relapse, health resource utilization, and medical costs. Patients and methods Commercially insured MS patients (aged 18–65 years, two or more MS diagnoses, one or more DMT claims) with continuous eligibility 12 months before and after the first DMT claim date (index date) and no DMT claim during the pre-index period were identified from a large commerical claims database for the period from January 1, 2008, to September 30, 2015. Adherence to the index DMT was measured by the 12-month post-index proportion of days covered (PDC) and compared between oral and injectable DMT initiators. After adjustment for sex, age at index DMT, and comorbidities, regression models examined the relationship between adherence and relapse risk, MS-related health resource utilization, and non-drug medical costs (2015 US$). Results The study covered 12,431 patients and nine DMTs. Adherence to the index DMT did not differ significantly between oral (n=1,018) and injectable (n=11,413) DMTs when assessed by mean PDC (0.7257±0.2934 vs 0.7259±0.2869, respectively; P =0.0787), or percentages achieving PDC ≥0.8 (61.4% vs 58.6%, respectively; P =0.0806). Compared to non-adherence, adherence to DMT significantly reduced the likelihood of relapse in the post-index 12 months by 42%, hospitalization by 52%, and emergency visits by 38% (all, P <0.0001). Adherent patients would be expected to have on average 0.7 fewer outpatient visits annually versus non-adherent patients ( P <0.0001). Based on the differences in predicted mean costs, adherence (vs non-adherence) would decrease the total annual medical care costs by $5,816 per patient, including hospitalization costs by $1,953, emergency visits by $171, and outpatient visits by $2,802. Conclusion Adherence remains suboptimal but comparable between oral and injectable DMTs. Potential health and economic benefits underscore the importance of improving adherence in MS.

Disease-Modifying Therapy Adherence and Associated Factors in a National Sample of Medicare Patients With Multiple Sclerosis

“…Nevertheless, evidence from privately insured patients suggests that nonadherence to MS DMTs is associated with an increased risk of relapse and health resource utilization. 35,36 Future research should examine whether similar findings are identified in the Medicare population.…”

Knowledge Is Power, but Is Ignorance Bliss? Optimising Conversations About Disease Progression in Multiple Sclerosis

“…Despite the risks, there are also considerable benefits to open communication regarding MS disease progression. Slowing disease progression is the primary aim of HCPs treating MS [27]; however, real-world studies show treatment discontinuation and non-adherence rates of around 30% [28][29][30][31]. Indeed, the actual rates of non-adherence may be even higher than reported [32].…”

Modeling the impact of patient treatment preference on health outcomes in relapsing-remitting multiple sclerosis

“…In addition, research has found that adherence varies widely across studies, with estimates ranging from 47% to 93% 8,[11][12][13][14] . Adherence is critically important given that it is associated with reduced relapse rates [14][15][16] , improved health-related quality of life 17 , better physical outcomes 18 , and lower healthcare utilization and costs 15,19,20 .…”