Use and cost of disease-modifying therapies by Sonya Slifka Study participants: has anything really changed since 2000 and 2009?

Abstract

Background Disease-modifying therapies benefit individuals with relapsing forms of multiple sclerosis, but their utility remains unclear for those without relapses. Objective To determine disease-modifying therapy use and costs in 2009, compare use in 2009 and 2000, and examine compliance with evidence-based guidelines. Methods We determined the extent and characteristics of disease-modifying therapy use by participants in the Sonya Slifka Longitudinal Multiple Sclerosis Study (Slifka) in 2000 ( n =2156) and 2009 ( n =2361) and estimated out-of-pocket and total (payer) costs for 2009. Two multivariable logistic regressions predicted disease-modifying therapy use. Results Disease-modifying therapy use increased from 55.3% in 2000 to 61.5% in 2009. In 2009, disease-modifying therapy use was reported by 76.5% of participants with relapsing-remitting multiple sclerosis, 73.2% with progressive-relapsing multiple sclerosis, 62.5% with secondary progressive multiple sclerosis, and 41.8% with primary progressive multiple sclerosis. Use was significantly associated with relapsing-remitting multiple sclerosis, shorter duration of illness, one to two relapses per year, non-ambulatory symptoms, using a cane, younger age, higher family income, and having health insurance. Average annual costs in 2009 were US$939–3101 for patients and US$16,302–18,928 for payers. Conclusion Use rates were highest for individuals with relapsing-remitting multiple sclerosis, but substantial for those with progressive courses although clinical trials have not demonstrated significant benefits for them.

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

“…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.…”

“…Those with a higher risk of not being on DMT, compared with those with private insurance, were more likely to be uninsured (aOR 0.46; 95% CI, 0.24-0.89), 17 have any publicly funded insurance (OR 1.75; 95% CI, 1.33-2.28), 18 be on Medicaid (32.5% on DMT vs. 52.1%, p < 0.001), 19 or have Medicare Advantage with Part D (MAPD) (35-39 year age group, p = 0.002; age > 40, p < 0.001). 20 PwMS taking DMT were more likely to have ESI plans than those not taking DMT (90% vs. 65%, p < 0.001).…”

The Interactive Web-Based Program MSmonitor for Self-Management and Multidisciplinary Care in Persons With Multiple Sclerosis: Quasi-Experimental Study of Short-Term Effects on Patient Empowerment

“…Self-management perspectives and goals may differ between relapsing remitting, secondary progressive, and primary progressive patients. Moreover, the failure to detect a change in the PIH adherence to treatment score may relate to the fact that 9 of the 19 patients were not treated with a DMD, whereas only 2 of the DMD-treated patients reported (a low number of) missed doses [45]. Actually, the low incidence of DMD treatment in our patients may be explained by the fact that 1 out of 4 had progressive MS, and that in general 1 out of 4 patients with relapsing-remitting MS is not treated with a DMD [45].…”

“…Moreover, the failure to detect a change in the PIH adherence to treatment score may relate to the fact that 9 of the 19 patients were not treated with a DMD, whereas only 2 of the DMD-treated patients reported (a low number of) missed doses [45]. Actually, the low incidence of DMD treatment in our patients may be explained by the fact that 1 out of 4 had progressive MS, and that in general 1 out of 4 patients with relapsing-remitting MS is not treated with a DMD [45]. Third, we included 5 patients in the MSmonitor group with reportedly low computer skills and 1 patient with reportedly no such skills, without offering them further training or education.…”