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Evaluating Treatment Patterns, Relapses, Healthcare Resource Utilization, and Costs Associated with Disease-Modifying Treatments for Multiple Sclerosis in DMT-Naïve Patients

Authors Freeman L, Kee A, Tian M, Mehta R

Received 27 October 2020

Accepted for publication 27 December 2020

Published 22 January 2021 Volume 2021:13 Pages 65—75


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Samer Hamidi

Leorah Freeman,1 Arianna Kee,2 Marc Tian,2 Rina Mehta2

1Dell Medical School, The University of Texas at Austin, TX, USA; 2Bristol Myers Squibb, Princeton, NJ, USA

Correspondence: Leorah Freeman
Health Discovery Building, Dell Medical School, The University of Texas at Austin, 1601 Trinity Street, Austin, TX 78701, USA
Tel + 1-512-495-5355

Purpose: Early diagnosis and treatment of multiple sclerosis (MS) with disease-modifying therapy (DMT) can reduce relapse number and severity, which has cost implications. We describe treatment patterns, healthcare utilization, and cost among MS patients newly initiating DMTs (index).
Patients and Methods: DMT-naïve adults with 12 months’ continuous enrollment pre- and post-index and ≥ 2 MS claims (2009‒2018) were identified from the Optum Clinformatics Data Mart database. Treatment adherence and persistence were measured as time on index DMT. Relapses were identified using a validated claims-based algorithm. All-cause and MS-related healthcare expenditures and utilization were captured pre- and post-index. Outcomes were stratified by route of administration. Multivariate analyses assessed differences in outcomes and costs.
Results: The analysis included 5906 MS patients (mean age, 46.6 years). The majority initiated injectable (63.5%) followed by oral (28.8%) and infusion (7.7%) DMTs. Post-index, 45.3% of patients were nonadherent and 39.4% were nonpersistent. Relapse rates decreased from pre- to post-index (oral: 24.3%‒16.1%; injectable: 25.0%‒17.1%; infusion: 29.3%‒15.5%). Post-index mean (SD) all-cause total costs were lowest with oral ($70,970 [$36,681]) vs injectable ($82,521 [$58,569]) and infusion ($80,871 [$49,627]) DMTs. MS-related total costs were lowest with oral ($65,149 [$65,133]) vs injectable ($76,197 [$60,204]) and infusion ($72,703 [$47,287]) DMTs. Multivariate analysis showed no differences between oral and injectable DMTs in adherence, persistence, or relapse rate; however, oral DMTs had significantly lower all-cause and MS-related costs.
Conclusion: With similar outcomes across DMT administration routes, initiating the least costly DMT may be warranted for many patients. In newly treated MS patients, the need exists to improve adherence and persistence.

Keywords: administrative claims, healthcare costs, treatment adherence and compliance, drug administration routes

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