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Abstract
Objective
The objective of this study was to describe and compare health care resource utilization (HCRU) and disease modifying treatment (DMT) use among US adults <65 years with multiple sclerosis (MS), across commercial and Medicare Advantage plans.
Methods
Medical and pharmacy claims data from commercial and Medicare Advantage with Part D (MAPD) plans were extracted for MS patients age 18 − 64 identified between 1 January 2014 and 31 May 2017. Comparisons were made between commercial and MAPD enrollees for all-cause HCRU and DMT use over 1 year, overall and by 5 year age groups.
Results
A total of 28,427 MS patients were identified; two-thirds (67%) had commercial coverage. MAPD patients had statistically significantly higher mean counts of all-cause inpatient, emergency room (ER) and ambulatory visits compared to commercial patients. The significant differences were evident in all age groups ≥30 years, except for ER visits in the 40–44 and 60–64 age groups. MAPD patients had statistically significantly lower prevalence of DMT use compared to commercial patients in all age groups starting at ≥35 years.
Conclusion
MAPD patients had a higher burden of medical HCRU compared to their commercially insured counterparts, most likely due primarily to their more advanced disease state and higher level of MS-related disability. Reasons for lower prevalence of DMT use among MAPD patients may include their more advanced disease state, older age and higher prevalence of comorbid conditions compared with commercially insured patients, as well as more restrictive formularies for MAPD vs. commercial plans. These findings suggest that there may be an opportunity for recently approved DMTs indicated for active secondary progressive MS to fulfill an unmet need for treatment among MS patients <65 years without contraindicated comorbid conditions who are enrolled in MAPD plans. Novel therapies under development to delay progression may help keep MS patients of working age in the work force.
Transparency
Declaration of funding
This study was funded by Novartis Pharmaceuticals Corporation Inc. Novartis coauthors collaborated with Optum in the design of the study and interpretation of results.
Declaration of financial/other relationships
M.C., B.G., E.H. and H.T. have disclosed that they were all employees of Optum, which was commissioned by Novartis to conduct this study. L.B. has disclosed that she was a Health Economics & Outcomes Research Fellow at Thomas Jefferson University at the time of this study, and was sponsored by Novartis. V.P., K.J. and P.A.R. have disclosed that they were all employees at Novartis when this study was conducted. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Author contributions
M.C., L.B., H.T., V.P. and P.A.R. conceived and designed the study. B.G. and E.H. analyzed study data, and B.G. confirmed that the statistical tables are correct. M.C., L.B., H.T., V.P., K.J. and P.A.R. interpreted study results. All authors were involved in drafting or reviewing the manuscript, have provided final manuscript approval, and agree to be accountable for all aspects of the work.
Acknowledgements
We would like to thank Virginia M. Rosen PhD for her assistance with the preparation of this manuscript. Dr. Rosen is employed by Optum Inc. which was contracted by Novartis Pharmaceuticals Corporation Inc. to conduct this study and produce the manuscript.
Previous presentation
Preliminary results of this study were presented previously. Cisternas MG, Bartolome L, Gitar B, Hulbert E, Trenz H, Patel V, Johnson K, Russo PA. Healthcare resource utilization among multiple sclerosis patients <65 years of age with commercial or Medicare Advantage coverage: real-world evidence from an administrative claims database. AMCP Nexus 2019; 2019 Oct 29–Nov 1; National Harbor, MD.