Patterns and Trends of Healthcare Utilization among People with Multiple Sclerosis in the Age of Disease-Modifying Therapy: an Analysis of Administrative Claim Data from a Commercially Insured Population in the United States, 2004-2013

Objective: To compare healthcare expenditure and utilization in multiple sclerosis (MS) across disease-modifying treatments (DMTs). Background: DMTs contributes to the high cost of MS care. Their role in healthcare expenditure and utilization warrants detailed examination. Design/Methods: We performed retrospective analyses of claim data from a commercially insured MS population (2004–2013). We defined MS cohort entry as the third occurrence of ICD-9 code for MS. We included patients on monotherapy of DMTs: high-efficacy (HE: natalizumab) and standard-efficacy (SE: interferon-beta, glatiramer acetate, fingolimod, dimethyl fumarate and teriflunomide). We ascertained the healthcare expenditure based on insurance claims (USD) over time. We measured the incidence rate of key healthcare utilizations: hospitalizations, emergency visits, doctor visits, neurologist visits, MRI of brain and spinal cord, and steroid infusions. We calculated the incidence rate ratio (IRR) across groups using Poisson regression, with either patients never on any DMT (ND) or patients treated with interferon-beta as reference, adjusting for relevant covariates. Results: Our cohort included 31,772 patients (mean age=45 years, 75% women), all with >=3 months of insurance coverage preceding MS cohort entry. Both HE (β=USD32,725.2, p Conclusions: This study suggests that DMT costs are potentially the main driver of high healthcare expenditure in MS, and highlights the need for prospective comparative studies towards value-based medicine. Disclosure: Dr. Zhu has nothing to disclose. Dr. Tang has nothing to disclose. Dr. Landon has nothing to disclose. Dr. Isfort has nothing to disclose. Dr. Franklin has nothing to disclose. Dr. Cai has nothing to disclose. Dr. Seeger has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Optum Life Sciences. Dr. Xia has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Roche, Genentech, and Merck. Dr. Xia has received research support from Subtle Medical.