All-Cause Health Care Utilization and Costs Associated with Newly Diagnosed Multiple Sclerosis in the United States

Abstract

BACKGROUND: Multiple sclerosis (MS) is a costly and crippling neurologic disease. Approximately 250,000 to 400,000 persons in the United States are currently diagnosed with MS. Most individuals experience their first symptoms between the ages of 20 and 40 years; therefore, this disease may have substantial impact over many years of life on health, quality of life, productivity, and employment. Whereas a number of studies have utilized a cross-sectional design to evaluate the costs associated with MS, no study has used a large administrative claims database to analyze the direct costs associated with newly diagnosed MS.

Managed Approaches to Multiple Sclerosis in Special Populations

“…91 Total all-cause health care costs for MS patients, over a 12-month post-index period, were 4.7 times the cost for health comparison patients ($18,829 vs. $4,038, P < 0.001), with 7.5-fold higher pharmacy costs. 91 The economic evaluation described previously by Kobelt took into account both direct costs (inpatient and ambulatory care, prescription medications, and other services) and indirect costs (e.g., lost workplace productivity). 79 Annual costs increased from an average of $32,297 for patients with EDSS scores less than 4.0 (normal neurologic exam to mild or moderate disability) 7 to $64,492 for those with EDSS scores greater than 6.0 (walking assistance needed to complete dependence).…”

“…With the release of this long-term data and the potential for these results to be extrapolated to other medications in the interferon class (e.g., Rebif and Avonex), economic analysis of DMTs is necessary. Asche et al (2010) analyzed the health care utilization and costs associated with newly diagnosed MS patients (over the initial 12 months after diagnosis) compared with otherwise healthy patients with similar demographic and other variables (e.g., region, insurance type, gender, age, and enrollment period). 91 Total all-cause health care costs for MS patients, over a 12-month post-index period, were 4.7 times the cost for health comparison patients ($18,829 vs. $4,038, P < 0.001), with 7.5-fold higher pharmacy costs.…”

“…Asche et al (2010) analyzed the health care utilization and costs associated with newly diagnosed MS patients (over the initial 12 months after diagnosis) compared with otherwise healthy patients with similar demographic and other variables (e.g., region, insurance type, gender, age, and enrollment period). 91 Total all-cause health care costs for MS patients, over a 12-month post-index period, were 4.7 times the cost for health comparison patients ($18,829 vs. $4,038, P < 0.001), with 7.5-fold higher pharmacy costs. 91 The economic evaluation described previously by Kobelt took into account both direct costs (inpatient and ambulatory care, prescription medications, and other services) and indirect costs (e.g., lost workplace productivity).…”

Frequency and Economic Impact of Comorbid Cardiac Conditions with Multiple Sclerosis

“…6,7 The estimated total all-cause medical costs are nearly 5 times higher per year for patients with MS compared with those without MS, with at least 25% of incremental costs attributed to drug therapy. 6 In the United States, it is estimated that the cost per patient per year can exceed $50,000 (2008 U.S. dollars), 8 while the estimated total lifetime cost to a patient is $4.1 million (2010 U.S. dollars). 9,10 The cost per patient is dependent on many factors, including choice of therapy, the type of MS, disease progression, as well as comorbid conditions.…”

“…9,10 The cost per patient is dependent on many factors, including choice of therapy, the type of MS, disease progression, as well as comorbid conditions. 6,9 An understanding of the frequency of comorbid conditions is crucial, since certain comorbidities may affect the choice of immunomodulatory therapy. Specifically, fingolimod, the sphingosine 1-phosphate receptor modulator, is contraindicated in patients with recent myocardial infarction…”