Adherence to disease-modifying therapies for multiple sclerosis and subsequent hospitalizations

Evans, Charity; Marrie, Ruth Ann; Zhu, Feng; Leung, Stella; Lu, Xinya; Kingwell, Elaine; Zhao, Yinshan; Tremlett, Helen

doi:10.1002/pds.4207

Cited by 32 publications

(28 citation statements)

References 46 publications

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“…This correlation was previously reported [1,4]. Non-adherence in MS is further related to suboptimal response to treatment [32], including disease relapse [32], decreased QoL, and need for more expensive healthcare, such as increased number of emergency department visits and hospitalizations [8,33].…”

Section: Discussionsupporting

confidence: 70%

Adaptation and validation of a Spanish version of the treatment burden questionnaire in patients with multiple sclerosis

et al. 2019

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Background: The Treatment Burden Questionnaire (TBQ) is a self-reported measure of the effect of treatment workload on patient wellbeing. We sought to validate the TBQ in Spanish and use it to estimate the burden of treatment in Argentinian patients with multiple sclerosis (MS). Methods: The TBQ was forward-backward translated into Spanish. Two focus groups and 25 semi-structured interviews focused on wording and possible item exclusion. Validation was performed in 2 steps. First, 162 patients across a range of MS severity completed the questionnaire. Confirmatory factor analysis assessed the dimensional structure of the TBQ. Construct validity was assessed by studying correlations with fatigue and quality of life (QoL). Then, in a second cohort of 171 patients, we evaluated the association between TBQ scores and patients' sex, age, education level, employment status, type of MS, disease duration, comorbidities, EDSS, pharmacological treatment and medication adherence. Results: The questionnaire presented a 3-factor structure in which burden was related to pharmacological treatment; comprehensive health assistance; and psycho-social-economic context. Composite reliability was > 0.8 for all factors. TBQ showed positive correlation with fatigue (r s = 0.467, p = 0.006), negative correlation with QoL (r s − 0.446, p = 0.009). For the second cohort, total TBQ score was 43 (SD 29). Lowest scores were observed on self-monitoring (0.53, SD 1.3) and highest for administrative load (4.2, SD 3.4). Inverse association was found between the TBQ score and medication adherence (r 0.243 p = 0.001). TBQ scores also correlated with daily patient pill/injection requirements (r 0.175 p = 0.020). Individuals receiving injectable treatment scored higher than patients on oral drugs (total TBQ 51 (SD 32) vs 39 (SD 27) p = 0.002). Conclusions: The TBQ in Spanish is a reliable instrument and showed adequate correlation with QoL and adherence scales in MS patients. TBQ may benefit health resources allocation and provide tailor therapeutic interventions to construct a minimally disruptive care.

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Section: Discussionsupporting

confidence: 70%

Adaptation and validation of a Spanish version of the treatment burden questionnaire in patients with multiple sclerosis

et al. 2019

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show abstract

“…This correlation was previously reported (1,4). Non-adherence in MS is further related to suboptimal response to treatment (32), including disease relapse (32), decreased QoL, and need for more expensive healthcare, such as increased number of emergency department visits and hospitalizations (8,33).…”

Section: Discussionsupporting

confidence: 74%

Adaptation and Validation of a Spanish version of the Treatment Burden Questionnaire in Patients with Multiple Sclerosis

Ysrraelit¹,

Fiol

Peña

et al. 2019

Preprint

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Background: The Treatment Burden Questionnaire (TBQ) is a self-reported measure of the effect of treatment workload on patient wellbeing. We sought to validate the TBQ in Spanish and use it to estimate the burden of treatment in Argentinian patients with multiple sclerosis (MS). Methods: The TBQ was forward-backward translated into Spanish. Two focus groups and 25 semi-structured interviews focused on wording and possible item exclusion. Validation was performed in 2 steps. First, 162 patients across a range of MS severity completed the questionnaire. Confirmatory factor analysis assessed the dimensional structure of the TBQ. Construct validity was assessed by studying correlations with fatigue and quality of life (QoL). Then, in a second cohort of 171 patients, we evaluated the association between TBQ scores and patients' sex, age, education level, employment status, type of MS, disease duration, comorbidities, EDSS, pharmacological treatment and medication adherence. Results: The questionnaire presented a 3-factor structure in which burden was related to pharmacological treatment; comprehensive health assistance; and psycho-social-economic context.Composite reliability was > 0.8 for all factors. TBQ showed positive correlation with fatigue (rs= 0.467, p=0.006), negative correlation with QoL (rs -0.446, p=0.009). For the second cohort, total TBQ score was 43 (SD 29). Lowest scores were observed on self-monitoring (0.53, SD 1.3) and highest for administrative load (4.2, SD 3.4). Inverse association was found between the TBQ score and medication adherence (r 0.243 p=0.001). TBQ scores also correlated with daily patient pill/injection requirements (r 0.175 p=0.020). Individuals receiving injectable treatment scored higher than patients on oral drugs (total TBQ 51 (SD 32) vs 39 (SD 27) p=0.002). Conclusions: The TBQ in Spanish is a reliable instrument and showed adequate correlation with QoL and adherence scales in MS patients. TBQ may benefit health resources allocation and provide tailor therapeutic interventions to construct a minimally disruptive care.

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“…The first definition required ≥3 hospital, physician, or drug claims, and has been previously validated by Marrie et al, and used in other Canadian provinces and observational research. [15][16][17][18][19][20][21] The second definition, released by the Canadian Chronic Disease Surveillance System (CCDSS), required ≥1 hospitalization or ≥5 physician claims within 2 years. 5 Hospital transfers and re-admissions within 1 day of a discharge date were considered as one hospitalization episode and collapsed into a single hospital claim.…”

Section: Case Definitions and Validationmentioning

confidence: 99%

Establishing the Incidence and Prevalence of Multiple Sclerosis in Saskatchewan

Al-Sakran

Marrie

Blackburn

et al. 2018

Can. J. Neurol. Sci.

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Objective: To validate a case definition of multiple sclerosis (MS) using health administrative data and to provide the first province-wide estimates of MS incidence and prevalence for Saskatchewan, Canada. Methods: We used population-based health administrative data between January 1, 1996 and December 31, 2015 to identify individuals with MS using two potential case definitions: (1) ≥3 hospital, physician, or prescription claims (Marrie definition); (2) ≥1 hospitalization or ≥5 physician claims within 2 years (Canadian Chronic Disease Surveillance System [CCDSS] definition). We validated the case definitions using diagnoses from medical records (n = 400) as the gold standard. Results: The Marrie definition had a sensitivity of 99.5% (95% confidence interval [CI] 92.3-99.2), specificity of 98.5% (95% CI 97.3-100.0), positive predictive value (PPV) of 99.5% (95% CI 97.2-100.0), and negative predictive value (NPV) of 97.5% (95% CI 94.4-99.2). The CCDSS definition had a sensitivity of 91.0% (95% CI 81.2-94.6), specificity of 99.0% (95% CI 96.4-99.9), PPV of 98.9% (95% CI 96.1-99.9), and NPV of 91.7% (95% CI 87.2-95.0). Using the more sensitive Marrie definition, the average annual adjusted incidence per 100,000 between 2001 and 2013 was 16.5 (95% CI 15.8-17.2), and the age-and sex-standardized prevalence of MS in Saskatchewan in 2013 was 313.6 per 100,000 (95% CI 303.0-324.3). Over the study period, incidence remained stable while prevalence increased slightly. Conclusion: We confirm Saskatchewan has one of the highest rates of MS in the world. Similar to other regions in Canada, incidence has remained stable while prevalence has gradually increased. RÉSUMÉ: Établir l'incidence et la prévalence de la sclérose en plaques en Saskatchewan. Objectif: Au moyen de données administratives relatives à la santé, valider une définition des cas de sclérose en plaques (SP) et fournir les premières estimations de l'incidence et de la prévalence de la SP en Saskatchewan. Méthodes: Les données administratives que nous avons utilisées se rapportaient à la période allant du 1 er janvier 1996 au 31 décembre 2015 et étaient relatives à la population de la Saskatchewan. Nous avons ainsi cherché à identifier des individus atteints de SP au moyen de deux définitions de cas potentielles : (1) ≥3 demandes de remboursement d'un hôpital, actes facturés par un médecin ou demandes de règlement relatives à un médicament sur ordonnance (définition de Marrie); (2) ≥1 hospitalisation ou ≥5 actes facturés par un médecin au cours de deux ans (définition du Système canadien de surveillance des maladies chroniques [SCSMC]). À titre de norme de référence, nous avons ensuite validé ces définitions de cas en nous référant à des diagnostics établis dans des dossiers médicaux (n = 400). IC 95 %, 96,9), une VPP de 98,9 % (IC 95 %, 96,9) et une VPN de 91,7 % (IC 95 %, 87,0). À l'aide de la définition de Marrie, plus sensible, il appert que l'incidence moyenne annuelle ajustée de SP par 100 000 habitants était, entre 2001. En ce qui regarde la ...

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Adherence to disease-modifying therapies for multiple sclerosis and subsequent hospitalizations

Abstract: Hospitalization rates were lower in subjects with optimal DMT adherence, but findings were not statistically significant. Prior hospitalization and polypharmacy were associated with increased risk for future hospitalizations in MS. Copyright © 2017 John Wiley & Sons, Ltd.

Cited by 32 publications

References 46 publications

Adaptation and validation of a Spanish version of the treatment burden questionnaire in patients with multiple sclerosis

Adaptation and validation of a Spanish version of the treatment burden questionnaire in patients with multiple sclerosis

Adaptation and Validation of a Spanish version of the Treatment Burden Questionnaire in Patients with Multiple Sclerosis

Establishing the Incidence and Prevalence of Multiple Sclerosis in Saskatchewan

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