Comparing costs and absences for multiple sclerosis among US employees: pre- and post-treatment initiation

Abstract

Background:

Limited data exist on the effects of Disease Modifying Treatments (DMTs) on direct and indirect costs among employees treated for Multiple Sclerosis (MS). The objective was to compare costs and absences among employees treated with DMTs (e.g., interferons [IFNs]: IFN-β1a-IM = Avonex = ‘A’, IFN-β1b = Betaseron = ‘B’, IFN-β1a-SC = Rebif = ‘R’, or glatiramer acetate = Copaxone = ‘C’) for MS pre and post therapy initiation.

Methods:

A healthcare claims database of US employees (2001–2008) was used to identify patients with two or more DMT prescriptions or one DMT prescription with a MS diagnosis (ICD-9 = 340.X) who were continuously employed and with health plan coverage 6 months pre and post DMT initialization. Outcome measures included: direct costs; indirect costs and absences associated with sick leave (SL) and short-term disability (STD); and medical costs and utilization by place of service (POS). All costs are inflation-adjusted to 2010 US$. Between- and within-group outcomes were compared using Student’s t-tests for continuous and chi-square tests for discrete variables and considered significant when P ≤ 0.05.

Results:

Overall, 153 eligible employees were identified: ‘A’ = 68, ‘B’ = 22, ‘R’ = 21, ‘C’ = 42; 76 employees had SL eligibility; 89 had STD eligibility; and 97 employees had POS indicators. Following treatment initiation, healthcare costs decreased significantly for ‘A’ users (−53.8%, −$3084) and ‘B’ users (−67.1%, −$4103), while SL costs only decreased significantly for ‘A’ users (−60.5%, −$704); changes in SL absence days for ‘A’ and ‘B’ users were significantly lower than for ‘C’ users (both P < 0.05). In the POS sample, total medical costs significantly decreased for ‘A’ (−$3643), ‘B’ (−$3470), and ‘C’ (−$3762), while ‘R’ increased ($2093) non-significantly. Only ‘A’ users had significant proportion-of-care reductions (Emergency Department, Outpatient Hospital, and ‘Other’ locations).

Conclusion:

Among MS employees treated with DMTs in the real-world, ‘A’ and ‘B’ users had significantly greater reductions in SL costs post therapy initiation compared with ‘C’ and ‘R’. Only ‘A’ users showed a significant reduction in SL absence days, while the other cohorts reported increases.

Limitations:

Small sample sizes may limit the interpretability of these results.

Key words::

• Absenteeism
• Costs of care/healthcare expenditures
• Health Services/economics
• Health Services/utilization
• Multiple sclerosis
• Multiple sclerosis/drug therapy

Transparency

Declaration of funding

Financial support for this study was provided by Biogen Idec, Inc., Cambridge, MA, USA.

Declaration of financial/other relationships

N.L.K. and I.A.B. have disclosed that they are employed by HCMS Group, a company that received funding from Biogen to conduct this research. K.R. has disclosed that she is employed by Biogen Idec. R.A.B. has disclosed that he is an employee of the JeSTARx Group, a company that received funding from Biogen for its role in this research.

Acknowledgments

For assistance with reviews of the data and drafts of this manuscript, the authors thank James E. Smeeding, RPh, MBA, President of the JeSTARx Group, and Harold H. Gardner, MD, President of HCMS. The authors also acknowledge Conny Burkett, RPh, Partner, Paradigm Consulting, Inc., for assistance with the editing of this manuscript.

Notes

* Avonex is a registered trade name of Biogen Idec Pharmaceuticals, Cambridge, MA, USA.

† Betaseron is a registered trademark of Bayer HealthCare Pharmaceuticals Inc., West Haven, CT, USA.

‡ Rebif is a registered trademark of EMD Serono, Inc., Rockland, MA, USA and its affiliates.

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