Identifying disability level in multiple sclerosis patients in a U.S.-based health plan claims database
ECTRIMS Online Library. Berkovich R. 09/13/19; 279554; 293
Regina Berkovich
Regina Berkovich
Contributions
Abstract

Abstract: 293

Type: Scientific Session

Abstract Category: Clinical aspects of MS - Economic burden

R. Berkovich1, E. Fox2, A. Okai3, Y. Ding4, M. Gorritz4, L. Bartolome5, R.L. Wade4, W. Su6, P. Russo6

1Los Angeles County USC General Hospital and Clinic, Los Angeles, CA, 2Central Texas Neurology Consultants, Round Rock, 3Multiple Sclerosis Treatment Center of Dallas, Dallas, TX, 4IQVIA, Inc., Plymouth Meeting, 5Jefferson College of Population Health, Philadelphia, PA, 6Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States

Background: The economic burden of multiple sclerosis (MS) has been reported to increase with disease severity. Expanded Disability Status Scale (EDSS) score, the clinical trial gold standard to measure the level of MS disease severity, is not usually recorded in claims or electronic medical record (EMR) data in the United States (US).
Objective: Develop EDSS-based criteria for assigning MS disability level in a nationally representative U.S. claims database.
Methods: Claims data linked to EMR were used to assign an EDSS proxy-aligned measure of disability to MS patients. Patients ≥ 20 years old with MS (diagnosis between 1 Jan 2012 - 31 Dec 2016 index) and ≥ 1 year of continuous enrollment in the US-based IQVIA claims database prior to and after index were included. Patients with EMR linkage (n=1,599) comprised the core sample in which EDSS-related symptoms, determined by clinical narrative in the EMR were extracted. Symptoms were mapped to ICD-9/10 and durable medical equipment codes, grouped by functional system, and assigned a severity level by three independent MS-specialist physicians. Assignment of disability level (mild, moderate, severe) was based on the pre-index MS symptoms (anchored to EDSS < 4, 4-6.0, >6.0 respectively). Criteria were then applied to MS patients in the full claims sample (N=45,687). Generalized linear model-adjusted all-cause costs (2017 US$) by disability level were estimated for the 1-year post-index period.
Results: Mean age was 49 years with 78% and 76% female in the core and full sample, respectively. Most reflected mild disability at index (58% core sample; 66% full sample). Adjusted mean annual costs were highest in severe patients: $56,206, trailed by moderate: $53,488 and mild: $46,691 in the full sample. Cost increases between disability levels were similar between cohorts: 15% and 20% (both p< .0001) higher in moderate and severe than mild patients (full); 12% (p=0.01) and 23% (p< .001) higher in moderate and severe than mild patients(core).
Conclusions: This is the first US study using claims and EMR to classify MS disability level, an important indicator of MS progression, using all eight functional systems of the EDSS. The proxy-aligned approach advances the opportunity to examine outcomes by disability accumulation in the absence of standard markers of disease progression. Additional research validating the criteria in patients with available EDSS score is warranted.
Disclosure: This study was sponsored by Novartis. Berkovich R, Fox E and Okai A provide consulting services to Novartis. Ding Y, Gorritz M and Wade R are employees of IQVIA that received consulting fees to conduct research on this study. Bartolome L is a postdoctoral research fellow at Novartis. Su W and Russo P are employees of Novartis.

Abstract: 293

Type: Scientific Session

Abstract Category: Clinical aspects of MS - Economic burden

R. Berkovich1, E. Fox2, A. Okai3, Y. Ding4, M. Gorritz4, L. Bartolome5, R.L. Wade4, W. Su6, P. Russo6

1Los Angeles County USC General Hospital and Clinic, Los Angeles, CA, 2Central Texas Neurology Consultants, Round Rock, 3Multiple Sclerosis Treatment Center of Dallas, Dallas, TX, 4IQVIA, Inc., Plymouth Meeting, 5Jefferson College of Population Health, Philadelphia, PA, 6Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States

Background: The economic burden of multiple sclerosis (MS) has been reported to increase with disease severity. Expanded Disability Status Scale (EDSS) score, the clinical trial gold standard to measure the level of MS disease severity, is not usually recorded in claims or electronic medical record (EMR) data in the United States (US).
Objective: Develop EDSS-based criteria for assigning MS disability level in a nationally representative U.S. claims database.
Methods: Claims data linked to EMR were used to assign an EDSS proxy-aligned measure of disability to MS patients. Patients ≥ 20 years old with MS (diagnosis between 1 Jan 2012 - 31 Dec 2016 index) and ≥ 1 year of continuous enrollment in the US-based IQVIA claims database prior to and after index were included. Patients with EMR linkage (n=1,599) comprised the core sample in which EDSS-related symptoms, determined by clinical narrative in the EMR were extracted. Symptoms were mapped to ICD-9/10 and durable medical equipment codes, grouped by functional system, and assigned a severity level by three independent MS-specialist physicians. Assignment of disability level (mild, moderate, severe) was based on the pre-index MS symptoms (anchored to EDSS < 4, 4-6.0, >6.0 respectively). Criteria were then applied to MS patients in the full claims sample (N=45,687). Generalized linear model-adjusted all-cause costs (2017 US$) by disability level were estimated for the 1-year post-index period.
Results: Mean age was 49 years with 78% and 76% female in the core and full sample, respectively. Most reflected mild disability at index (58% core sample; 66% full sample). Adjusted mean annual costs were highest in severe patients: $56,206, trailed by moderate: $53,488 and mild: $46,691 in the full sample. Cost increases between disability levels were similar between cohorts: 15% and 20% (both p< .0001) higher in moderate and severe than mild patients (full); 12% (p=0.01) and 23% (p< .001) higher in moderate and severe than mild patients(core).
Conclusions: This is the first US study using claims and EMR to classify MS disability level, an important indicator of MS progression, using all eight functional systems of the EDSS. The proxy-aligned approach advances the opportunity to examine outcomes by disability accumulation in the absence of standard markers of disease progression. Additional research validating the criteria in patients with available EDSS score is warranted.
Disclosure: This study was sponsored by Novartis. Berkovich R, Fox E and Okai A provide consulting services to Novartis. Ding Y, Gorritz M and Wade R are employees of IQVIA that received consulting fees to conduct research on this study. Bartolome L is a postdoctoral research fellow at Novartis. Su W and Russo P are employees of Novartis.

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