Study Finds Severity of Multiple Sclerosis Relapses Increases Cost Burden

Cincinnati—Multiple sclerosis (MS) relapses were associated with higher direct and indirect costs for MS patients, according to a new retrospective study. The findings from the study were recently presented during a poster session at the AMCP meeting. The poster was titled Direct and Indirect Costs Associated with Relapse of Multiple Sclerosis.

MS is associated with a significant economic burden due to the chronic, debilitating nature of the neurological disease; however, researchers in this study wanted to learn more about how the severity of MS relapses effects the direct and indirect healthcare costs associated with MS.

Using a retrospective longitudinal cohort design, researchers began by gathering health insurance claims data and employer disability data from the OptumHealth Reporting and Insights database. According to the poster, the database includes medical and pharmacy claims data for more than 13 million privately insured people covered by 60 self-insured companies. In addition, the database also includes short- and long-term disability data for employees in 29 companies.

Researchers used enrollment records and patient demographics, medical and pharmacy claims data, and short- and long-term disability claims data to determine the all-cause and MS-related direct and indirect costs of MS patients at 12 months and up to 36 months of follow-up.

Using an operational claims-based algorithm, researchers divided patients into 1 of 3 different categories including: (1) a high-severity cohort, which included 515 patients who had at least 1 relapse of high severity; (2) a low/moderate-severity cohort, which included 1220 patients who had at least 1 relapse of low or moderate severity; and (3) a no-relapse cohort for the 7686 patients in the study who did not have a relapse.

To be included in the study, participants had to be at least 18 years of age, with ≥2 primary or secondary diagnoses for MS, at least 180 days of observation before the MS onset, and at least 365 days of observation after the onset of the disease.

To determine direct costs, researchers assessed the data based on 4 mutually exclusive components: (1) hospitalizations, (2) emergency department visits, (3) outpatient visits, or (4) pharmacy dispensing. Indirect costs, by contrast, were determined by examining disability and medically related absenteeism costs for employees with disability coverage.

Researchers found that the 2 relapse groups had significantly higher annual all-cause direct costs after 12 months of follow-up compared with the no-relapse cohort. For instance, the all-cause healthcare costs for the low/moderate-severity group were $28,348 compared with $17,545 for the no-relapse group (adjusted cost difference [CD] of $8,269), while the high-severity group had the highest costs at $41,969. The positive relationship between the severity of MS relapses and the cost burden remained at the 36-month follow-up as well.

All-cause and MS-related indirect costs were also higher for patients in both relapse groups compared with the no-relapse cohort at 12 months and again at 36 months. According to the results, the high-severity group had all-cause indirect costs of $9226 after 12 months of follow-up, compared to $5610 in the low/moderate-severity group and $3949 in the no-relapse group.

Researchers acknowledged study limitations, including possible omissions or inaccuracies in the claims data, a possible underestimation of indirect costs for the employer, and possible confounding effects.

This study was supported by Novartis Pharmaceuticals.