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Healthcare resource use and disease progression among commercially insured patients with multiple sclerosis: a comparison of continuous and intermittent users of disease modifying therapy over five years (2012-2016)
Author(s): ,
L. Amezcua
Affiliations:
Dept. of Neurology, Keck School of Medicine, USC, Los Angeles, CA
,
M. Williams
Affiliations:
The Multiple Sclerosis Center of Atlanta, Atlanta, GA
,
A. Paradis
Affiliations:
Biogen, Weston, MA, United States
,
J. Zhou
Affiliations:
Biogen, Weston, MA, United States
,
Q. Hou
Affiliations:
Biogen, Weston, MA, United States
T. Livingston
Affiliations:
Biogen, Weston, MA, United States
ECTRIMS Online Library. Amezcua L. Oct 12, 2018; 229126
Lilyana Amezcua
Lilyana Amezcua
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Abstract: P1286

Type: Poster Sessions

Abstract Category: Therapy - Others

Background: Research suggests that non-persist use of disease modifying therapy (DMT) can lead to sub-optimal outcomes among multiple sclerosis (MS) patients. It is therefore important to understand real-world DMT utilization patterns and characterize how continuous vs. intermittent DMT use may impact health resource utilization (HRU) and MS disease progression over time.
Objective: To identify continuous and intermittent DMT users among commercially insured patients with MS and compare their HRU and disability progression over 5 years.
Methods: A retrospective claims analysis was conducted using Truven MarketScan Databases. Among continuous enrollees from 2011-2016, MS patients were identified for the index year of 2012 (>2 ICD-9 340 claims, or 1 diagnosis + DMT claim) and then classified by DMT utilization. Continuous users included those with >1 DMT claim each year from 2012-2016, while intermittent users included those with >1 DMT claim in at least one but not all years during this period. Propensity score matching was used to balance the cohorts across confounders from the pre-index period/index date (2011-2012), including age, gender, pre-index relapses, comorbidities, and geographic region. We then compared HRU (total, by type of service) and markers of disability progression (time to cane/walker, wheelchair; annualized relapse rates [ARR]; time to relapse) across continuous and intermittent DMT users.
Results: In total, 15,543 MS patients were identified. Approximately half (52%) were continuous users and 26% were intermittent users. 4,022 propensity score matched pairs were included in analyses. Over 5 years, continuous vs. intermittent users had significantly less total HRU (p< 0.0001), a significant reduction in inpatient, outpatient, emergency room utilization, and shorter average hospital stays (p< 0.001 for all service types). In contrast to intermittent users, continuous users had a trend reduction in time to cane/walker (28.3 vs. 24.6 months), a significant reduction in time to wheelchair (24.8 vs. 23.3 months; p< 0.001), lower ARR (p< 0.0001), and longer time to relapse (20.3 vs. 19.4 months; p< 0.001).
Conclusions: Results from this real-word assessment suggest that MS patients that are continuously on DMT are more likely to experience greater benefits across time, including less HRU and slower disease progression. Further research is needed to better understand the barriers behind intermittent DMT users.
Disclosure: This research was funded by Biogen. LA has served as a consultant to Biogen, Celgene, and Genzyme and receives research funding from Novartis and Biogen. MW has served on scientific advisory boards, received funding for travel, received speaker honoraria, been a consultant, and/or served on speakers´ bureaus for Biogen, Teva Neuroscience, Bayer, Questcor Pharmaceuticals, EMD Serono, Pfizer, Novartis, Acorda, and Genzyme. AP, JZ, QH, and TL are employees of, and hold stock and/or stock options in, Biogen.

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