PND2 Cost Offsets and Gains in Health Effects in the Treatment of Relapsing–Remitting Multiple Sclerosis with Laquinimod: An Analysis Based on the Allegro Trial

Abstract

COHE physicians who more often adopted occupational health best practices had 57% fewer disability days (p ϭ 0.001) compared with patients treated by COHE physicians who less frequently adopted best practices. CONCLUSIONS: Physician financial incentives, coupled with care management support, can improve outcomes and reduce costs for patients receiving occupational health care. OBJECTIVES:Kyphosis due at least one vertebral compression fracture (VCF) is prevalent among osteoporotic patients, resulting in well documented symptoms and impact on functioning and well-being. Assessing health outcomes of interventions concentrates on consequences of back pain, omitting relevant aspects of increased morbidity. A three-part study led to development of a conceptual measurement framework for comprehensive assessment of symptoms, impact and treatment benefits in kyphosis. METHODS: We developed a literature-based (PubMed, Medline) Disease Model (DM) for kyphosis for selecting and developing outcome measures, as recommended by regulatory agencies. In-depth interviews were conducted among patients (nϭ10) and physicians (nϭ10) to test the DM. Physician respondents were PCPs or specialists currently treating patients with osteoporotic kyphosis. Patient respondents were Ͼ50 years old with an osteoporotic VCF Ͼϭ 90 days prior. Relevant Patient-Reported Outcome instruments (PROs) were evaluated for appropriateness in this population. RESULTS: The DM included signs, symptoms, causes/triggers, exacerbations, and functional/well-being impact of kyphosis. The DM content was largely confirmed by all respondents, however patients offered new concepts of emotional and functional impact and clinicians discounted psychosocial concepts (well-being and sleep impairment) and added clinical evaluations of the spinal deformity. Related to these findings, PRO instruments lacked adequate content validity or measurement properties for evaluating kyphosis outcomes. Close matches were the IOF Quality of Life questionnaire (Qualeffo-41) and the Osteoporosis Assessment Questionnaire (OPAQ), though neither includes gastrointestinal or respiratory symptoms. CONCLUSIONS: This study confirms the need for more comprehensive assessment of health outcomes in kyphosis, because current approaches omit key concepts (gastrointestinal and respiratory symptoms) and functional impact being a major cost-driver. A comprehensive evaluation of the severity and impact of kyphosis requires clinician evaluation of spinal deformity and patient-report of symptoms (spinal, respiratory, GI) and functional impact and a more complete understanding of the unique information provided by different measurements.