Healthcare resource utilization following switch or discontinuation in multiple sclerosis patients on disease modifying drugs

Abstract

Objective: The objective of this study was to explore the cost and utilization in the period following discontinuations or switches of disease modifying drugs (DMDs) for patients with multiple sclerosis (MS). Secondary objectives included an assessment of the time to switch or discontinuation from index DMD treatment.

Methods: Cases were defined as a billed MS diagnosis in continuously enrolled patients initiated with interferon-β1a IM, interferon-β1b SC, glatiramer acetate, and interferon-β1a SC found in the PharMetrics Patient-Centric Database. Information on patient demographics, diagnoses, procedures, pharmacy-dispensed drugs, and costs was extracted; reasons for discontinuation and expenses outside of the healthcare system were not available. Treatment discontinuations and switches between study drugs were defined using pharmacy prescription patterns and analyzed by descriptive and regression methods. The non-pharmacy medical costs in the 18 months following switching or discontinuation were compared to the costs in a randomly selected similar period for those patients who did not switch or discontinue these agents.

Results: A total of 5,772 MS patients were continuously enrolled and were treated with one or more of the four drugs of interest, and about half of these patients switched drugs or discontinued treatment for at least 90 days. Patients initiated with interferon-β1b SC were more likely to discontinue treatment compared to interferon-β1a IM users. Non-pharmaceutical medical costs were highest for those switching treatments followed by those discontinuing DMDs in the 18 months following a switch or discontinuation, compared to persistent users of these drugs. Interferon β1b SC initiators had higher costs following changes or discontinuations, while glatiramer acetate and interferon-β1a SC users had lower subsequent costs compared to interferon-β1a IM users.

Limitations: Unfortunately, the reasons for stopping the initial treatment cannot be determined from analysis of an administrative claims database. Also, the MS cases followed in this analysis are billing diagnostic events unconfirmed through a review of medical records or other data sources. The results are unstratified in terms of severity and thus while treatment patterns may vary for patients with different types of MS (e.g., progressive vs. relapsing-remitting), this cannot be examined in this analysis.

Conclusion: Changing or discontinuing DMDs is common among MS patients and is associated with higher non-pharmaceutical medical costs that vary based on the initiating drug and other demographics characteristics.

Key words::

• costs
• costs analysis
• interferon-beta
• patient compliance

Transparency

Declaration of funding: This study was funded by Biogen Idec.

Declaration of financial/other relationships: MWR has disclosed that he is an employee of United BioSource Corp, which received funding for this project, and that he is a consultant to Biogen Idec on other similar projects. RS has disclosed that he is an employee of United BioSource Corp. CS has disclosed that he is a consultant and advisor for United BioSource Corp. KR has disclosed that she is an employee of Biogen Idec.

The JME peer reviewers 1 and 2 have not received an honorarium for their review work on this manuscript. Both have disclosed that they have no relevant financial relationships.

Acknowledgments: The authors would like to acknowledge the scientific support and direction provided by Dr Beth Nordstrom of United BioSource Corporation.

Notes

* Copaxone is a registered trademark of Teva Pharmaceutical Industries Ltd, Petach Tikva, Israel.

† Avonex is a registered trademark of Biogen Idec, Cambridge, MA, USA.

‡ Betaseron is a registered trademark of Bayer HealthCare Pharmaceuticals, Leverkusen, Germany.

§ Rebif is a registered trademark of EMD Serono, Inc., Rockland, MA, USA.