Health care resource utilization and disease modifying treatment use in multiple sclerosis patients by age and insurance type

Cisternas, Miriam G.; Bartolome, Lauren; Gitar, Bret; Hulbert, E.; Trenz, Helen; Patel, Vikram; Johnson, Kristen; Russo, Patrícia A.

doi:10.1080/03007995.2021.1885367

Cited by 6 publications

(7 citation statements)

References 16 publications

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“…To address this, a large phase 4 randomized controlled DMD treatment discontinuation trial is currently underway in the Unites States which includes persons ≥55 years old, and its findings may add crucial knowledge to this emerging aspect of MS care ( 49 ). While, as expected, a smaller proportion of our older (versus younger) persons with MS were DMD exposed ( 22 , 32 , 50 ), we also observed that the proportions of persons continuing or discontinuing DMD were similar. Specifically, the proportions of persons who initiated their first DMD before age 55 years, and who continued or discontinued once aged ≥55 years were rather similar (n=706/1,302 versus n=596/1,302, respectively) ( Supplementary Table 3 ).…”

Section: Discussionsupporting

confidence: 84%

“…The authors found that MS persons with a federal insurance plan had a significantly higher mean count of all-cause inpatient and ambulatory visits compared to those with a commercial insurance plan. While findings were consistent across age groups, at least once age 30 years was reached, the authors did not report which individual DMDs contributed to these findings ( 32 ). Efforts have also been made to examine the effects of ageing on the efficacy of DMDs by using data from clinical trials.…”

Section: Discussionmentioning

confidence: 96%

“…While several studies have assessed the relationship between the MS DMDs and healthcare utilization ( 9 – 12 ), we were unable to find another study to compare our age-specific findings. A study from the United States co-authored by a pharmaceutical manufacturer of an MS DMD examined patterns of healthcare utilization in 28,427 persons with MS by insurance type (commercial versus the federal insurance plan, Medicare Advantage) within different age groups ( 32 ). However, the study was cross-sectional in design, spanning just one-year and was restricted to persons under 65 years of age.…”

Section: Discussionmentioning

confidence: 99%

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Disease-Modifying Drug Uptake and Health Service Use in the Ageing MS Population

Graf

Zhu

et al. 2022

Front. Immunol.

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BackgroundEvidence regarding the efficacy or effectiveness of the disease-modifying drugs (DMDs) in the older multiple sclerosis (MS) population is scarce. This has contributed to a lack of evidence-based treatment recommendations for the ageing MS population in practice guidelines. We examined the relationship between age (<55 and ≥55 years), DMD exposure and health service use in the MS population.MethodsWe conducted a population-based observational study using linked administrative health data from British Columbia, Canada. We selected all persons with MS and followed from the most recent of their first MS or demyelinating event, 18th birthday or 01-January-1996 (index date) until the earliest of emigration, death or 31-December-2017 (study end). We assessed DMD exposure status over time, initially as any versus no DMD, then by generation (first or second) and finally by each individual DMD. Age-specific analyses were conducted with all-cause hospitalizations and number of physician visits assessed using proportional means model and negative binomial regression with generalized estimating equations.ResultsWe included 19,360 persons with MS (72% were women); 10,741/19,360 (56%) had ever reached their 55th birthday. Person-years of follow-up whilst aged <55 was 132,283, and 93,594 whilst aged ≥55. Any DMD, versus no DMD in the <55-year-olds was associated with a 23% lower hazard of hospitalization (adjusted hazard ratio, aHR0.77; 95%CI 0.72-0.82), but not in the ≥55-year-olds (aHR0.95; 95%CI 0.87-1.04). Similar patterns were observed for the first and second generation DMDs. Exposure to any (versus no) DMD was not associated with rates of physician visits in either age group (<55 years: adjusted rate ratio, aRR1.02; 95%CI 1.00-1.04 and ≥55 years: aRR1.00; 95%CI 0.96-1.03), but variation in aRR was observed across the individual DMDs.ConclusionOur study showed beneficial effects of the DMDs used to treat MS on hospitalizations for those aged <55 at the time of exposure. In contrast, for individuals ≥55 years of age exposed to a DMD, the hazard of hospitalization was not significantly lowered. Our study contributes to the broader understanding of the potential benefits and risks of DMD use in the ageing MS population.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Disease-Modifying Drug Uptake and Health Service Use in the Ageing MS Population

Graf

Zhu

et al. 2022

Front. Immunol.

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“…Overall, studies examining the type of medical insurance suggest that pwMS with private insurance, compared with public insurance such as Medicare or Medicaid, tend to have improved access to DMTs, less health care resource utilization, and less physical disability but a more poor subjective experience including more health care worry and worse perceptions of the quality of their coverage despite less depression. [17][18][19][20][21][25][26][27] Among those who are privately insured, those with HMO plans may have improved access to DMT and lower disability and disease activity than those on PPO plans, [22][23][24]32,34 though more studies are needed to better understand this finding.…”

Section: Discussionmentioning

confidence: 99%

The impact of medical insurance on health care access and quality for people with multiple sclerosis in the United States: A scoping review

Moghavem,

Castañeda,

Chatfield

et al. 2023

Mult Scler

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Background: In the United States, health insurance coverage and quality mediate access to health care, a key social determinant of health. Objective: To perform a scoping review regarding the impact of insurance coverage and benefit design on health care access and both clinical and quality of life outcomes in people with MS (pwMS). Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were followed. A literature search was conducted from January 2010 to February 2022. Included studies were in English, peer-reviewed, US-based, and evaluated elements of insurance and their relationship with access and quality outcomes for adult pwMS. Results: Our search identified 1619 articles, of which 32 met inclusion criteria. Privately insured pwMS were more likely to be on disease-modifying therapy (DMT). Increased out-of-pocket spending was associated with lower DMT adherence and greater discontinuation rates. Access to specialty pharmacy programs was associated with improved DMT adherence. Conclusion: Health insurance coverage and design strongly influences health care for pwMS in the United States and may be a modifiable social determinant of health. Increased pharmaceutical cost-sharing is associated with declines in DMT utilization and adherence. Further study is needed to better characterize the impacts of other core elements of health insurance, including prior authorization requirements and step therapy.

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“…Recent studies on treatment utilization in patients with MS 6–8 have not reported utilization in reproductive‐aged women who have complex health concerns related to family planning. The objective of our study was to describe trends in the monthly prevalence of DMT use, overall and by type of DMT, among commercially‐insured, reproductive‐aged women with MS from 2010–2019.…”

Section: Introductionmentioning

confidence: 99%

Trends in the use of disease‐modifying therapies among reproductive‐aged women with multiple sclerosis in the United States from 2010 to 2019

Duchesneau

Kinlaw

Funk

et al. 2022

Pharmacoepidemiology and Drug

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Purpose Multiple sclerosis (MS) is a chronic disease of the central nervous system that disproportionately affects women, with typical onset during reproductive age. Several disease‐modifying therapies (DMTs) are FDA‐approved to slow disease progression, but are not indicated for use during pregnancy. Our objective was to describe trends over time (2010–2019) in monthly point prevalence of DMT use among reproductive‐age women, overall and by generic name. Methods This study used administrative claims data from the US during 2009–2019 to identify women age 15–44 with MS and continuous insurance coverage for ≥12 months. DMTs were identified using prescription fills and procedural claims for alemtuzumab, daclizumab, dimethyl fumarate, fingolimod, glatiramer acetate, interferon beta, mitoxantrone, natalizumab, ocrelizumab, and teriflunomide. Monthly prevalent use was defined as ≥1 days' supply of a DMT in the month. Age‐ and region‐standardized monthly prevalence was estimated nonparametrically. Results Among 42 281 reproductive‐aged women over 818 179 person‐months, DMT use increased from a minimum monthly prevalence of 49.3% (February, 2011) to a maximum of 58.7% (April, 2019). In 2010, prevalence of injectable DMTs was 43.1% compared to 2.5% for oral DMTs; by 2014, however, oral DMTs (26.5%) surpassed injectable DMTs (23.7%) as the most common route of administration. In the most recent data available (December, 2019), the most common DMTs were dimethyl fumarate, glatiramer acetate, and fingolimod. Conclusions DMT use among reproductive‐aged women has rapidly evolved during the past decade. Collaborative treatment decision making between women with MS and clinicians may help optimize MS care and improve DMT uptake during reproductive years.

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Health care resource utilization and disease modifying treatment use in multiple sclerosis patients by age and insurance type

Cited by 6 publications

References 16 publications

Disease-Modifying Drug Uptake and Health Service Use in the Ageing MS Population

Disease-Modifying Drug Uptake and Health Service Use in the Ageing MS Population

The impact of medical insurance on health care access and quality for people with multiple sclerosis in the United States: A scoping review

Trends in the use of disease‐modifying therapies among reproductive‐aged women with multiple sclerosis in the United States from 2010 to 2019

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