Clinical and economic impact of a specialty care management program among patients with multiple sclerosis: a cohort study

Abstract

Background: To evaluate the clinical and economic impact of a specialty care management program among patients with multiple sclerosis.Methods: This retrospective cohort analysis included patients aged ≥18 years with ≥2 claims of multiple sclerosis diagnosis and ≥1 multiple sclerosis medications from 1 January 2004 to 30 April 2008. The outcome metrics included medication adherence and persistence, multiple sclerosis-related hospitalization, and multiple sclerosis-related cost. Multivariate analyses were performed to adjust for demographics and clinical characteristics.Results: Among the 3993 patients identified, 78.3% participated in the program and 21.7% did not. Over 12 months, medication adherence and persistence improved among participants but deteriorated among non-participants (medication possession ratio change: +0.08 vs −0.03, p < 0.001; persistence change: +29.2 days vs −9.2 days, p < 0.001). Multiple sclerosis-related hospitalization decreased from 9.6% to 7.1% for participants, whereas it increased from 10.1% to 12.0% for the non-participant group (p < 0.001). Multiple sclerosis-related medical spending (non-pharmacy) decreased among participants, but it increased among non-participants (mean: −US$264 vs + US$1536, p < 0.001). Total multiple sclerosis-related cost for both groups increased over time (+US$4471 vs +US$4087, p < 0.001).Conclusions: This program was associated with improved medication adherence and persistence, reduced multiple sclerosis-related hospitalization, and decreased multiple sclerosis-related medical costs. Unfortunately, the cost savings in the medical component did not offset the increased pharmacy expenditures during the 12-month follow-up period.

Narrative Review of the Literature on Adherence to Disease-Modifying Therapies Among Patients with Multiple Sclerosis

“…15 Nonadherence to DMTs has been shown to have a negative impact on clinical outcomes, including higher rates of relapse and disease progression, 16,17 as well as an increase in hospital resource utilization. 18 However, according the the European Multiple Sclerosis Therapy Consensus Group (MSTCG) guidelines, patients may discontinue treatment with DMTs after 3 years, if there is no evidence of relapse and/or progression. 19 This review focuses on patient adherence to therapy, a distinct concept from persistence to therapy.…”

Managed Approaches to Multiple Sclerosis in Special Populations

“…43 Problems with injections, perceived lack of efficacy, and side effects have been identified as major barriers to long-term adherence in patients with MS. 54 MCOs have an interest in clinical programs that can reduce the higher medical expenditures incurred by MS patients. 52 A condition management program for MS described by Tan et al (2010) was associated with improved medication adherence and persistence, reduced MS-related hospitalizations, and decreased MS-related medical costs. 55 However, the authors concluded that the cost savings in the medical component (-$264) during the 12-month follow-up period did not offset the increased pharmacy expenditures for MS drugs (+$2,184).…”

“…52 A condition management program for MS described by Tan et al (2010) was associated with improved medication adherence and persistence, reduced MS-related hospitalizations, and decreased MS-related medical costs. 55 However, the authors concluded that the cost savings in the medical component (-$264) during the 12-month follow-up period did not offset the increased pharmacy expenditures for MS drugs (+$2,184). Interventions included direct mailing of medication and disease-specific patient education materials to patients, including refill reminder calls.…”

“…Interventions included direct mailing of medication and disease-specific patient education materials to patients, including refill reminder calls. 55 Previous studies have demonstrated the feasibility of MS management programs for patient education, exercise, depression, and energy conservation in patients with MS. [56][57][58][59] Approximately 20% to 25% of MS patients will require long-term care during their disease course, and approximately 5% may eventually need care in an assisted living or nursing facility. 60,61 Nursing home residents with MS represent a unique population subset, differing in a number of ways from most other residents.…”

Opportunities and Challenges of Specialty Pharmaceuticals

“…Over the past decade, specialty drug care management programs have shown positive outcomes in the quality of care for disease states such as hemophilia, 8 MS, [9][10][11] HIV, 12 and other diseases. Specialty management strategies include custom formularies and benefit designs, clinical utilization management, provider reimbursement contracts, fraud and billing error monitoring, and distribution channel management.…”