Determinants of high cost in multiple sclerosis patients: a claims and chart review study

Abstract

Objective: To identify factors associated with high cost multiple sclerosis (MS) patients using integrated administrative claims and medical charts data.

Methods: This study identified newly diagnosed MS patients (≥18 years) in a large United States managed care claims database between 1 January 2007 and 30 April 2011 using the ICD-9-CM code (340.xx). Mean annualized MS-related costs higher than the third quartile were categorized as high cost, lower than the first quartile as low, and the rest as medium. Patients were compared across cohorts with descriptive and inferential statistics. Baseline high cost factors were identified with multivariable logistic regression models.

Results: Administrative claims (n = 4342) and medical chart records (n = 400) data was evaluated. Mean (SD) annualized MS-related costs were $6313 ($14,177) for patients overall and $18,398 ($24,483) for high cost patients. Inpatient costs accounted for the largest proportion (49.69%) of MS-related costs among high cost patients. MS relapses and MS-related comorbidities were more prevalent in the high cost patients. In the multivariable analyses, patients with baseline use of antidepressants or corticosteroids, baseline muscle weakness, and initial treatment from a non-neurologist were likelier to be high cost MS patients.

Limitations: MS-related clinical information was not completely available from medical chart data. The specificity of true MS-related costs may have been limited and the definition of the cost-based cohort segmentations was arbitrary.

Conclusions: Overall, baseline use of MS-related medications, the presence of baseline MS-related comorbidities, MS relapses, and MS-related hospitalizations were significantly associated with high cost patients. Future comparative effectiveness studies of currently approved disease modifying therapies for MS may help to identify best strategies for individual patients to minimize clinical events that are associated with high disease related costs.

Keywords:

• Administrative claims
• Disease modifying treatment
• Economic burden
• Medical charts review
• Multiple sclerosis
• Observational study

Transparency

Declaration of funding

This study was conducted by HealthCore Inc., an independent consulting firm, that received funding from Novartis Pharmaceuticals Corporation to help conduct this study.

Author contributions: X.K.: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, statistical analysis, study supervision or coordination. P.N.: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, statistical analysis, study supervision or coordination. R.S.: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, statistical analysis, study supervision or coordination, obtaining funding. D.F.E.L.: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, acquisition of data, statistical analysis, study supervision or coordination, obtaining funding. H.S.F.: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, statistical analysis, study supervision or coordination. B.B.T.: drafting/revising the manuscript for content, including medical writing for content. T.V.: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data.

Declaration of financial/other relationships

X.K. and B.B.T. have disclosed that they are employees of HealthCore Inc. D.F.E.L. has disclosed that she was an employee of HealthCore Inc. at the time of the study. R.S. has disclosed that he is an employee and stockholder of Novartis Pharmaceuticals Corporation. P.N. and H.S.F. have disclosed that they were remunerated by Novartis Pharmaceuticals Corporation for their consultancy services on this study. T.V. has disclosed that he has served on consulting and advisory boards for AbbVie, DeltaQuest, Genentech, Novartis, Novartis Canada, Oxford Pharmagenesis, Hoffman-La Roche, Teva Neuroscience, EMD Serono, WebMD/Medscape, and Rocky Mountain MS Center; he has received current and past clinical research grant funding from Avanir, Genzyme, Ono, Biogen, Teva, NIH/NINDS, Janssen Research & Development, MedImmune, Acorda, Rocky Mountain MS Center, and EMD Serono.

CMRO peer reviewer 1 has disclosed that he is an advisor to Pacira Inc. CMRO peer reviewer 2 has no relevant financial or other relationships to disclose.

Acknowledgments

The authors thank Elizabeth Marks BSc RPh (HealthCore Inc., Senior Medical Writer) for assisting with formatting and submission of the manuscript.