Impact of increasing adherence to disease-modifying therapies on healthcare resource utilization and direct medical and indirect work loss costs for patients with multiple sclerosis

Abstract

Objectives:

To estimate the effect of adherence to disease-modifying therapies (DMTs) among patients with multiple sclerosis (MS) on healthcare resource utilization (HRU) and costs, and model the impact of a 10 percentage point increase in adherence on these outcomes.

Methods:

Employed patients, 18–64 years old, with ≥2 MS diagnoses and ≥1 DMT claim during January 1, 2002 to September 30, 2012 were identified from a large commercially-insured US claims database. Adherence was measured as proportion of days covered (PDC) during follow-up. Multivariate regression analyses were conducted to estimate the effect of adherence on HRU related to urgent care (i.e., inpatient or emergency room visit), days of work loss, direct medical cost, and indirect work loss costs. Model coefficients were used to evaluate the impact of a 10 percentage point increase in adherence on the outcomes.

Results:

A total of 1510 patients were included (mean age = 43.4 years, 64% female). Patients with higher adherence had lower HRU, fewer days of work loss, and lower direct and indirect costs. A 10 percentage point increase in adherence significantly decreased the likelihood of an inpatient or emergency room visit by 9–19%, days of work loss by 3–8%, and direct and indirect costs by 3–5%, depending on the follow-up period (all p < 0.01).

Conclusions:

Increasing DMT adherence was found to significantly decrease urgent-care HRU, days of work loss, and direct and indirect costs among patients with MS.

• Multiple sclerosis
• Medication adherence
• Disease-modifying therapies
• Direct cost
• Indirect cost
• Work loss

Transparency

Declaration of funding

This study was funded by Biogen Idec, Cambridge, MA.

Declaration of financial/other relationships

MC and MSD are employees of Analysis Group, Inc., a consulting company that has received research grants from Biogen Idec, including one for the current study. SY and MD were employees of Analysis Group at the time of the study. MF, BB, SS, and RI are employees of Biogen Idec.

Acknowledgments

The authors take full responsibility for the content of the paper. The authors thank Batool Haider (Analysis Group, Inc.) for writing support.

Previous presentations

Parts of the manuscript were presented as a poster at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 19th Annual International Meeting in Montreal, Canada, May 31–June 4, 2014. Yermakov S, Davis M, Calnan M, et al. Effect of Improving Adherence to Disease-Modifying Agents on Healthcare Resource Utilization and Medical Costs in Patients With Multiple Sclerosis (PND34). Parts of the manuscript were also presented at the 2014 Joint Americas Committee for Treatment and Research in Multiple Sclerosis–European Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS-ECTRIMS) Meeting in Boston, MA, September 10–13, 2014. Yermakov S, Davis M, Calnan M, et al. Impact of Improved Adherence to Disease-Modifying Therapies on Healthcare Resource Utilization and Medical Costs for Patients with Multiple Sclerosis (P029).