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. 2018 Mar;2(1):31-41.
doi: 10.1007/s41669-017-0035-2.

Comparison of Disease-Modifying Therapies for the Management of Multiple Sclerosis: Analysis of Healthcare Resource Utilization and Relapse Rates from US Insurance Claims Data

Jacqueline Nicholas  1 , Aaron Boster  1 , Ning Wu  2 , Wei-Shi Yeh  2 , Monica Fay  2 , Jon Kendter  2 , Ming-Yi Huang  2 , Andrew Lee  3
Affiliations

Comparison of Disease-Modifying Therapies for the Management of Multiple Sclerosis: Analysis of Healthcare Resource Utilization and Relapse Rates from US Insurance Claims Data

Jacqueline Nicholas et al. Pharmacoecon Open. 2018 Mar.

Abstract

Background: Data on comparative healthcare resource utilization and costs associated with the newer oral disease-modifying therapies (DMTs) for managing relapsing-remitting multiple sclerosis (MS) in routine clinical practice are limited. The purpose of this study was to estimate healthcare resource utilization, costs, and relapse rates in the year after initiating treatment with dimethyl fumarate (DMF), interferon (IFN)-β, glatiramer acetate (GA), teriflunomide, or fingolimod in routine clinical practice for patients with MS who did not receive a DMT in the previous year.

Methods: Patients initiating DMF, IFNβ, GA, teriflunomide, or fingolimod were identified based on claims data from 2012 to 2015 in the Truven MarketScan Commercial Claims Databases (n = 4194). Healthcare resource utilization assessment included the proportion of patients who were hospitalized, or had emergency room (ER) or urgent care (UC) visits. Healthcare costs were estimated for 1 year before and 1 year after DMT initiation. Relapse episodes were identified based on a published claims-based algorithm and clinical input from the research investigators.

Results: After DMT initiation, significant reductions in the proportions of patients who were hospitalized or requiring ER/UC visits were observed in all patient cohorts (p < 0.001 and p < 0.05, respectively). Non-prescription medical costs decreased after DMT initiation, with the largest decrease observed in the DMF cohort (US$5761 reduction, p < 0.0001). Reductions in non-prescription medical costs were associated with decreased use of outpatient services and inpatient hospital stays, and have the potential to partially offset DMT costs.

Conclusions: DMT initiation is associated with reductions in healthcare resource utilization and non-prescription medical costs in routine clinical practice.

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Conflict of interest statement

Conflicts of interest

Jacqueline Nicholas has received research funding from Genzyme, Novartis, Teva, Biogen, and Alexion, and has received consulting and speaking honoraria from Genzyme, Novartis, Teva, Biogen, and Medtronic. Aaron Boster has received research funding from Genentech, Actelion, and Mallinckrodt, and has received consulting and speaking honoraria from Genzyme, Novartis, Teva, Biogen, and Medtronic. Monica Fay and Andrew Lee are employees of, and hold stock and/or stock options in, Biogen. Ning Wu, Wei-Shi Yeh, Jon Kendter, and Ming-Yi Huang were employees of Biogen at the time of the study.

Funding

This study was funded by Biogen (Cambridge, MA, USA).

Ethical approval

This article does not report data from any studies with human participants or animals performed by any of the authors.

Data Availability

The datasets analyzed in the present study are not publicly available because they were licensed with restrictions from a third-party source.

Figures

Fig. 1
Fig. 1
Patient selection process. DMT disease-modifying therapy, ICD-9-CM International Classification of Diseases, Ninth Revision, Clinical Modification, MS multiple sclerosis
Fig. 2
Fig. 2
Differences in non-prescription medical costs1 for 1 year before and 1 year after the index date for patients with multiple sclerosis and no DMT exposure during the year before the index date. 1Difference-in-difference analysis adjusted for confounders indicated that reduction of total non-prescription medical costs in the 1 year following DMT initiation versus the prior year were statistically significantly greater in the dimethyl fumarate cohort versus the interferon-β (p = 0.0012), glatiramer acetate (p = 0.0003), and teriflunomide (p = 0.005) cohorts. No significant differences in reduction in total non-prescription medical costs were observed between the dimethyl fumarate and fingolimod cohorts (p = 0.7553). DMT disease-modifying therapy
Fig. 3
Fig. 3
Annualized relapse rates for 1 year before and 1 year after the index date for patients with multiple sclerosis and no disease-modifying therapy exposure during the year before the index date
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