Health care resource utilization before and after natalizumab initiation among patients with multiple sclerosis in Germany

Figures & data

Figure 1 Study design.

Figure 2 Patient selection process.

Abbreviation: MS, multiple sclerosis.

Table 1 Baseline demographic and clinical characteristics of patients initiating treatment with natalizumab

Characteristic	All patients (N=193)	With prior DMT use (n=145)	Without prior DMT use (n=48)	P-valuea
Age, years
Mean (SD)	37.1 (10.2)	37.1 (9.8)	37.1 (11.4)	0.818
Median (range)	37 (19, 61)	38 (19, 60)	36 (21, 61)
Female gender, n (%)	125 (64.8)	91 (62.8)	34 (70.8)	0.384
Index year, n (%)
2009	37 (19.2)	26 (17.9)	11 (22.9)	0.747
2010	39 (20.2)	30 (20.7)	9 (18.8)
2011	55 (28.5)	40 (27.6)	15 (31.3)
2012	62 (32.1)	49 (33.8)	13 (27.1)
DCI score
Mean (SD)	0.88 (1.2)	0.99 (1.3)	0.54 (0.9)	0.031
Median (range)	0 (0.0, 5.0)	0 (0.0, 5.0)	0 (0.0, 3.0)
DCI conditions ≥5%, n (%)
Hemiplegia or paraplegia	40 (20.7)	34 (23.4)	6 (12.5)	0.149
Chronic pulmonary disease	38 (19.7)	31 (21.4)	7 (14.6)	0.403
Diabetes without complications	12 (6.2)	10 (6.9)	2 (4.2)	0.733
Mild liver disease	11 (5.7)	9 (6.2)	2 (4.2)	0.734
Prior DMT, n (%)
Glatiramer acetate (Copaxone^®)	42 (21.8)	42 (29.0)	0 (0.0)	Not applicable
Intramuscular interferon beta-1a (Avonex^®)	34 (17.6)	34 (23.4)	0 (0.0)
SC interferon beta-1b (Betaferon^®)	28 (14.5)	28 (19.3)	0 (0.0)
SC interferon beta-1a (Rebif^®)	28 (14.5)	28 (19.3)	0 (0.0)
SC interferon beta-1b (Extavia^®)	7 (3.6)	7 (4.8)	0 (0.0)
Fingolimod (Gilenya^®)	6 (3.1)	6 (4.1)	0 (0.0)
No prior DMT	48 (24.9)	0 (0.0)	48 (100)
Multiple sclerosis–related medications, n (%)
Corticosteroidsb	146 (75.6)	116 (80.0)	30 (62.5)	0.020
Immunosuppressants	10 (5.2)	7 (4.8)	3 (6.3)	0.712

Notes:

a P values for the comparison of the subgroups of patients with and without prior DMT use;

b dexamethasone, methylprednisolone, prednisolone, prednisone, or adrenocorticotropic hormone.

Abbreviations: DCI, Deyo-Charlson comorbidity index; DMT, disease-modifying therapy; SC, subcutaneous; SD, standard deviation.

Figure 3 Multiple sclerosis–related (A) hospitalizations and (B) inpatient costs.

Abbreviation: DMT, disease-modifying therapy.

Table 2 Health care resource utilization among overall patient sample before and after initiating treatment with natalizumab

Health care resource utilization	All patients (N=193)
	Pre-index	Post-index	Change	P-value
Number of hospitalizations
MS-related
Mean (SD)	1.1 (1.5)	0.2 (0.7)	−0.9 (1.4)	<0.001
Median (range)	0 (0, 8)	0 (0, 5)	0 (−6, 3)
All-cause
Mean (SD)	1.3 (1.8)	0.4 (1.1)	−0.9 (1.8)	<0.001
Median (range)	1 (0, 9)	0 (0, 11)	0 (−8, 9)
Number of inpatient days
MS-related
Mean (SD)	7.0 (10.7)	2.7 (20.5)	−4.3 (20.5)	<0.001
Median (range)	0 (0, 62)	0 (0, 277)	0 (−62, 238)
All-cause
Mean (SD)	9.6 (16.6)	5.0 (23.5)	−4.6 (25.0)	<0.001
Median (range)	4 (0, 113)	0 (0, 277)	0 (−113, 238)
Corticosteroid use
Mean (SD)	2.4 (2.5)	0.6 (1.3)	−1.8 (2.4)	<0.001
Median (range)	2 (0, 19)	0 (0, 8)	−1 (−19, 3)
Number of sick days
MS-related
Mean (SD)	29.8 (53.1)	21.8 (55.8)	−8.0 (59.7)	<0.001
Median (range)	1 (0, 326)	0 (0, 366)	0 (−308, 311)
All-cause
Mean (SD)	36.2 (58.5)	27.9 (61.4)	−8.3 (63.8)	<0.001
Median (range)	5 (0, 330)	0 (0, 366)	0 (−312, 256)
Number of all-cause disability days
Mean (SD)	33.2 (84.9)	39.7 (97.9)	6.6 (61.5)	0.436
Median (range)	0 (0, 365)	0 (0, 366)	0 (−158, 365)

Abbreviations: MS, multiple sclerosis; SD, standard deviation.

Figure 4 All-cause (A) hospitalizations and (B) inpatient costs.

Abbreviation: DMT, disease-modifying therapy.

Figure 5 Corticosteroid (A) use and (B) costs.

Abbreviation: DMT, disease-modifying therapy.

Figure 6 Percentage of patients with (A) multiple sclerosis–related and (B) all-cause sick days.

Abbreviation: DMT, disease-modifying therapy.

Table S1 Health care resource utilization among the subgroups of patients with and without prior DMT use before and after initiating treatment with natalizumab

Health care resource utilization	Patients with prior DMT use (n =145)				Patients without prior DMT use (n =48)
	Pre-index	Post-index	Change	P-value	Pre-index	Post-index	Change	P-value
Number of hospitalizations
MS-related
Mean (SD)	1.1 (1.5)	0.2 (0.7)	−0.9 (1.4)	<0.001	0.9 (1.3)	0.1 (0.4)	−0.8 (1.2)	<0.001
Median (range)	1 (0, 8)	0 (0, 5)	0 (−6, 3)		0 (0, 5)	0 (0, 2)	0 (−4, 1)
All-cause
Mean (SD)	1.4 (1.8)	0.50 (1.3)	−0.9 (1.8)	<0.001	1.2 (1.7)	0.3 (0.6)	−1.0 (1.7)	<0.001
Median (range)	1 (0, 9)	0 (0, 11)	0 (−7, 9)		1 (0, 8)	0 (0, 3)	−0.5 (−8, 2)
Number of inpatient days
MS-related
Mean (SD)	7.2 (11.2)	3.4 (23.5)	−3.8 (23.2)	<0.001	6.3 (9.3)	0.6 (2.1)	−5.7 (8.6)	<0.001
Median (range)	4 (0, 62)	0 (0, 277)	0 (−62, 238)		0 (0, 36)	0 (0, 13)	0 (−35, 2)
All-cause
Mean (SD)	9.8 (16.0)	5.6 (25.6)	−4.1 (25.2)	<0.001	9.2 (18.4)	3.0 (15.3)	−6.2 (24.5)	<0.001
Median (range)	4 (0, 104)	0 (0, 277)	0 (−66, 238)		1.5 (0, 113)	0 (0, 105)	−1.5 (−113, 105)
Corticosteroid use
Mean (SD)	2.6 (2.5)	0.5 (1.0)	−2.0 (2.4)	<0.001	2.1 (2.4)	0.9 (1.9)	−1.2 (2.1)	<0.001
Median (range)	2 (0, 19)	0 (0, 4)	−2 (−19, 3)		1 (0, 10)	0 (0, 8)	−0.5 (−7, 3)
Number of sick days
MS-related
Mean (SD)	32.6 (55.5)	24.9 (61.2)	−7.7 (65.2)	0.003	21.4 (44.5)	12.5 (33.8)	−8.9 (39.0)	0.012
Median (range)	4 (0, 326)	0 (0, 366)	0 (−308, 311)		0 (0, 209)	0 (0, 165)	0 (−162, 146)
All-cause
Mean (SD)	39.4 (61.1)	30.4 (64.5)	−9.0 (66.3)	0.001	26.7 (49.5)	20.5 (50.8)	−6.2 (56.1)	0.026
Median (range)	10 (0, 330)	1 (0, 366)	0 (−312, 256)		0 (0, 213)	0 (0, 270)	0 (−166, 249)
Number of all-cause disability days
Mean (SD)	37.8 (90.9)	45.7 (105.5)	7.9 (65.1)	0.386	19.1 (61.9)	21.7 (68.0)	2.6 (49.1)	1.000
Median (range)	0 (0, 365)	0 (0, 366)	0 (−158, 365)		0 (0, 365)	0 (0, 366)	0 (−123, 249)

Abbreviations: DMT, disease-modifying therapy; MS, multiple sclerosis; SD, standard deviation.