1
|
Fricke LM, Krüger K. Subgroup analyses and patterns of multiple sclerosis health service utilisation: A cluster analysis. Mult Scler J Exp Transl Clin 2024; 10:20552173241260151. [PMID: 38910839 PMCID: PMC11191614 DOI: 10.1177/20552173241260151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Background Previous investigations of multiple sclerosis (MS)-related healthcare have focused on utilisation of specific individual health services (e.g. hospital care, office-based neurologists) by people with MS (PwMS). Meanwhile, little is known about possible patterns of utilisation across health services and their potential differences across patient characteristics. Objective To comprehensively analyse and identify patterns of MS-related health service utilisation and detect patient characteristics explaining such patterns. Methods In 2021, we invited all PwMS insured by the largest insurance company in Lower Saxony, Germany, to take part in an online survey. We merged respondents' survey and health insurance claims data. We analysed MS-related health service utilisation and defined individual characteristics for subgroup analyses based on Andersen's Behavioural Model. We executed non-parametric missing value imputation and conducted hierarchical clustering to find patterns in health service utilisation. Results Of 6928 PwMS, 1935 responded to our survey and 1803 were included in the cluster analysis. We identified four distinct health service utilisation clusters: (1) regular users (n = 1130), (2) assistive care users (n = 443), (3) low users (n = 195) and (4) special services users (n = 35). Clusters differ by patient characteristics (e.g. age, impairment). Conclusion Our findings highlight the complexity of MS-related health service utilisation and provide relevant stakeholders with information allowing them to tailor healthcare planning according to utilisation patterns.
Collapse
Affiliation(s)
- Lara Marleen Fricke
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
- Center for Health Economics Research Hannover (CHERH), Hannover, Germany
| | - Kathrin Krüger
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
- Center for Health Economics Research Hannover (CHERH), Hannover, Germany
| |
Collapse
|
2
|
Mésidor M, Sylvestre MP, Marrie RA, Rousseau MC. Does age at diagnosis influence the use of health services for multiple sclerosis? Mult Scler Relat Disord 2020; 46:102555. [DOI: 10.1016/j.msard.2020.102555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/17/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022]
|
3
|
Ten-year disease progression in multiple sclerosis: walking declines more rapidly than arm and hand function. Mult Scler Relat Disord 2020; 45:102343. [PMID: 32674028 DOI: 10.1016/j.msard.2020.102343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/13/2020] [Accepted: 06/21/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS From a clinical perspective there is a difference in the decline of arm and hand function and leg function in patients with multiple sclerosis (PwMS). Therefore, this study investigated the course of walking and arm and hand functions in PwMS over the first 10 years after diagnosis, including whether any function declined earlier or faster. METHODS A long-term prospective follow-up study of an incidence cohort of 156 patients with a definite diagnosis of MS, either non-relapse onset (n=28) or relapse onset (n=128) type. Participants were systematically examined immediately after definite diagnosis, at 6 months, and at 1, 2, 3, 6 and 10 years. Walking was determined with the fast 10-meter timed walk test (10mTWT), arm and hand function with the Action Research Arm test (ARAT) and the nine-hole peg test (9HPT). The 10-year trajectories of walking and arm and hand functions were compared using standardized z-scores. RESULTS From 3 years onwards the z-scores of the arm and leg function were visually diverging, with a trend towards significance at 6 years, and at 10 years the 10mTWT z-score is significantly higher than the 9HPT. This difference is more pronounced in non-relapse onset patients than in patients with relapse onset type MS, but present in both groups over the first 10 years. In the non-relapse onset group a difference in z-scores at 10 years post-diagnosis between the 10m TWT and 9HPT was found of -12.94 (95% confidence interval (CI) -20.2 to -5.73) for the right and -10.14 (95% CI -17.3 to -2.93) for the left hand. In the relapse onset group there was a difference at 10 years post-diagnosis of -2.17 (95% CI -3.75 to -0.59) for the right and a difference of -2.29 (95% CI -3.87 to -0.71) for the left hand. CONCLUSION This is the first longitudinal study that shows that walking declines earlier and more rapidly than arm and hand function in patients with MS. These results give important insights that can be linked to the pathophysiological disease process regarding the ascending order of deterioration in patients with MS.
Collapse
|
4
|
Asano M, Eitzen A, Hawken K, Delima L, Finlayson M. Factors Associated with Postrelapse Rehabilitation Use in Multiple Sclerosis: A Pilot Survey. Int J MS Care 2019; 21:93-99. [PMID: 31191174 DOI: 10.7224/1537-2073.2017-092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Most people with multiple sclerosis (MS) have periodic and unpredictable relapses as part of their disease course. Relapses often affect functional abilities, resulting in diminished productivity and lower quality of life. Considering the effects, rehabilitation can play an important role in facilitating recovery; yet, the current literature suggests a lack of postrelapse rehabilitation services use. This study aims to document postrelapse rehabilitation services use and estimate the extent to which predisposing characteristics, perceived need, and enabling resources were associated with postrelapse rehabilitation services use in adults with MS. Methods This cross-sectional study used convenience sampling, and data from 73 adults with MS who recently had a relapse in the United States and Canada were analyzed. Results A total of 25 participants (34.2%) reported using postrelapse rehabilitation services. The regression model identified three variables associated with postrelapse rehabilitation services use: age (odds ratio [OR], 1.075), self-reported quality of life (considerably affected by the most recent relapse [OR, 5.717]), and presence of helpful health care providers (for obtaining postrelapse rehabilitation services [OR, 5.382]). Conclusions Most participants experienced a range of symptoms or limitations because of their most recent relapse, affecting their daily activity and quality of life. However, only one-third of the participants reported using postrelapse rehabilitation services, which focused on the improvement of their physical health. Regression modeling revealed that three population characteristics of the Andersen Behavioral Model of Health Services Utilization were associated with postrelapse rehabilitation services use.
Collapse
|
5
|
Alowayesh MS, Ahmed SF, Al-Hashel J, Alroughani R. Economic burden of multiple sclerosis on Kuwait health care system. PLoS One 2019; 14:e0216646. [PMID: 31086393 PMCID: PMC6516657 DOI: 10.1371/journal.pone.0216646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/26/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic neurological disease with heavy economic and social burdens resulting in significant disability. OBJECTIVE This study aims to (1) measure the cost of health resources utilization by MS patients and (2) to examine the difference in utilization and its attributed costs amongst patients who may have a different course of MS and expanded disability status scale (EDSS) scores. METHODS A cross-sectional study using Kuwait National MS registry was conducted to estimate the costs of utilization of resources from 2011 to 2015. RESULTS Between the period 2011-2015, 1344 MS patients were included in the registry. The average annual cost per MS patient has increased from $10,271 in 2011 to $17,296 in 2015. Utilization of disease-modifying therapies (DMTs) was the main driver of costs reaching 89.9% in 2015. Throughout the five-year period, the occurrence of relapses decreased from 21.8% to 12.2% (p <0.0001). During this same period, ambulatory relapse treatment increased by 5.8% while hospitalizations decreased by 2.6%. Patients with a moderate EDSS score (3.5-6) had the highest average cost (p<0.0001) compared to mild and severe EDSS scores. CONCLUSIONS Multiple sclerosis has been a significant economic burden on the Kuwait healthcare system. DMTs are the main driver of cost.
Collapse
Affiliation(s)
- Maryam S. Alowayesh
- Department of Pharmacy Practice, School of Pharmacy, Kuwait University, Jabriya, Kuwait
| | - Samar F. Ahmed
- Department of Neurology, Ibn Sina Hospital, Sabah Medical Area, Kuwait
- Department of Neurology and Psychiatry, Minia University, Minia, Egypt
| | - Jasem Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Sabah Medical Area, Kuwait
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| |
Collapse
|
6
|
Ney JP, Johnson B, Knabel T, Craft K, Kaufman J. Neurologist ambulatory care, health care utilization, and costs in a large commercial dataset. Neurology 2015; 86:367-74. [PMID: 26701378 DOI: 10.1212/wnl.0000000000002276] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 08/03/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the value of neurologist ambulatory care in chronic neurologic diseases in a large administrative claims dataset detailing costs, adverse events, and health care utilization. METHODS The Optum proprietary claims dataset (2010-2012) was examined to describe direct health care costs, as well as specific outcome metrics for a large population of persons with chronic neurologic illnesses. In phase I of the study, we detail neurologist involvement and differences in annualized allowed third--party payments within episode treatment groups (ETGs) for 10 neurologic illnesses. For phase II, we examined health care utilization for ETGs of epilepsy, Parkinson disease (PD), stroke, and multiple sclerosis (MS) with and without neurologist involvement. Reported outcomes were unadjusted differences and odds ratios between treatment groups. RESULTS For phase I, a total of 1,913,605 ETGs for 10 neurologic conditions were identified, 30.1% meeting criteria for neurologist involvement. All conditions had higher direct costs when neurologists were involved with care, ranging from a 25% increase for Alzheimer dementia to 100% more for MS care. In phase II, fractures, infections, emergent care, and inpatient admission were less with neurologist ambulatory care, while neurologist care was associated with greater utilization of disease-specific treatments (immunotherapies in MS anticoagulation in atrial fibrillation-associated stroke, deep brain stimulation and dopaminergic therapies in PD). CONCLUSION Neurologist involvement with care is associated with greater unadjusted allowed payments, but fewer adverse events and less acute care utilization.
Collapse
Affiliation(s)
- John P Ney
- From the Department of Neurology (J.P.N.), University of Washington, Seattle; Optum Insight (B.J., T.K.), Eden Prairie, MN; the Department of Human Services (K.C.), American Academy of Neurology, Minneapolis, MN; and Lifespan Physicians PSO (J.K.), Rhode Island Hospital, Providence, RI.
| | - Barbara Johnson
- From the Department of Neurology (J.P.N.), University of Washington, Seattle; Optum Insight (B.J., T.K.), Eden Prairie, MN; the Department of Human Services (K.C.), American Academy of Neurology, Minneapolis, MN; and Lifespan Physicians PSO (J.K.), Rhode Island Hospital, Providence, RI
| | - Tom Knabel
- From the Department of Neurology (J.P.N.), University of Washington, Seattle; Optum Insight (B.J., T.K.), Eden Prairie, MN; the Department of Human Services (K.C.), American Academy of Neurology, Minneapolis, MN; and Lifespan Physicians PSO (J.K.), Rhode Island Hospital, Providence, RI
| | - Karolina Craft
- From the Department of Neurology (J.P.N.), University of Washington, Seattle; Optum Insight (B.J., T.K.), Eden Prairie, MN; the Department of Human Services (K.C.), American Academy of Neurology, Minneapolis, MN; and Lifespan Physicians PSO (J.K.), Rhode Island Hospital, Providence, RI
| | - Joel Kaufman
- From the Department of Neurology (J.P.N.), University of Washington, Seattle; Optum Insight (B.J., T.K.), Eden Prairie, MN; the Department of Human Services (K.C.), American Academy of Neurology, Minneapolis, MN; and Lifespan Physicians PSO (J.K.), Rhode Island Hospital, Providence, RI
| |
Collapse
|
7
|
General Practitioner Preferences in Managing Care of Multiple Sclerosis Patients. Can J Neurol Sci 2015; 43:142-8. [DOI: 10.1017/cjn.2015.239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Multiple sclerosis (MS) is a lifelong neurological disorder requiring care in a variety of settings. The purpose of this study is to describe preferences of general practitioners (GPs) with regards to providing care for MS patients.Methods:A stratified sample of 900 GPs in the province of Quebec were sent a questionnaire, with 266 returning completed questionnaires. Respondents were surveyed about their preferences using four clinical scenarios describing hypothetical patients experiencing different stages of MS. Respondents were asked whether they would continue managing the patient themselves, formally refer the patient to a specialist, or seek specialist advice.Results:In two scenarios representing stable courses, 40.9% and 61.6% of GPs, respectively, intended to manage the patient themselves. GPs who reported having experience with MS patients were more likely to report an intention to continue management. In one scenario, GPs operating in rural areas were less likely to consider management than those in the Montreal metropolitan area (odds ratio=0.422, 95% confidence interval 0.20-0.90).Conclusions:For MS patients with a stable disease course, an important proportion of GPs appear to be willing to manage long-term care for MS patients.
Collapse
|
8
|
Hadjigeorgiou G, Dardiotis E, Tsivgoulis G, Doskas T, Petrou D, Makris N, Vlaikidis N, Thomaidis T, Kyritsis A, Fakas N, Treska X, Karageorgiou C, Sotirli S, Giannoulis C, Papadimitriou D, Mylonas I, Kouremenos E, Vlachos G, Georgiopoulos D, Mademtzoglou D, Vikelis M, Zintzaras E. Observational study assessing demographic, economic and clinical factors associated with access and utilization of health care services of patients with multiple sclerosis under treatment with interferon beta-1b (EXTAVIA). PLoS One 2014; 9:e113933. [PMID: 25419842 PMCID: PMC4242657 DOI: 10.1371/journal.pone.0113933] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 11/03/2014] [Indexed: 11/18/2022] Open
Abstract
Multiple sclerosis (MS) results in an extensive use of the health care system, even within the first years of diagnosis. The effectiveness and accessibility of the health care system may affect patients' quality of life. The aim of the present study was to evaluate the health care resource use of MS patients under interferon beta-1b (EXTAVIA) treatment in Greece, the demographic or clinical factors that may affect this use and also patient satisfaction with the health care system. Structured interviews were conducted for data collection. In total, 204 patients (74.02% females, mean age (SD) 43.58 (11.42) years) were enrolled in the study. Analysis of the reported data revealed that during the previous year patients made extensive use of health services in particular neurologists (71.08% visited neurologists in public hospitals, 66.67% in private offices and 48.53% in insurance institutes) and physiotherapists. However, the majority of the patients (52.45%) chose as their treating doctor private practice neurologists, which may reflect accessibility barriers or low quality health services in the public health system. Patients seemed to be generally satisfied with the received health care, support and information on MS (84.81% were satisfied from the information provided to them). Patients' health status (as denoted by disease duration, disability status and hospitalization needs) and insurance institute were found to influence their visits to neurologists. Good adherence (up to 70.1%) to the study medication was reported. Patients' feedback on currently provided health services could direct these services towards the patients' expectations.
Collapse
Affiliation(s)
| | | | - Georgios Tsivgoulis
- Second Department of Neurology, University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece
| | | | - Damianos Petrou
- Outpatient Clinic at Vostanio General Hospital of Mytilini, Mytilini, Greece
| | - Nikolaos Makris
- Neurology Department at Agios Andreas General University of Patra, Patra, Greece
| | - Nikolaos Vlaikidis
- 3rd University Neurology Department at Papanikolaou University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Thomas Thomaidis
- Neurology Department at Greek Red Cross Hospital, Athens, Greece
| | - Athanasios Kyritsis
- University Neurology Department at University Hospital of Ioannina, Ioannina, Greece
| | - Nikolaos Fakas
- Neurology Department at 401 Military Hospital of Athens, Athens, Greece
| | - Xoulietta Treska
- 2nd University Neurology Department at AHEPA General University Hospital of Thessaloniki, Thessaloniki, Greece
| | | | | | | | | | - Ioannis Mylonas
- Outpatient Clinic at Interbalcan Medical Center, Thessaloniki, Greece
| | | | | | | | - Despoina Mademtzoglou
- BECRO, Pharmaceutical Services, Athens, Greece
- Department of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece
| | - Michalis Vikelis
- Outpatient Clinic at Interbalcan Medical Center, Thessaloniki, Greece
- Medical Department, Novartis Hellas S.A.C.I., Athens, Greece
| | - Elias Zintzaras
- BECRO, Pharmaceutical Services, Athens, Greece
- Department of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece
- The Institute for Clinical Research and Health Policy Studies, Tufts University School of Medicine, Boston, MA, United States of America
| |
Collapse
|
9
|
Schoormans D, Sprangers MAG, van Melle JP, Pieper PG, van Dijk APJ, Sieswerda GT, Hulsbergen-Zwarts MS, Plokker THWM, Brunninkhuis LGH, Vliegen HW, Mulder BJM. Clinical and psychological characteristics predict future healthcare use in adults with congenital heart disease. Eur J Cardiovasc Nurs 2014; 15:72-81. [DOI: 10.1177/1474515114555819] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 09/25/2014] [Indexed: 01/22/2023]
Affiliation(s)
- Dounya Schoormans
- Department of Medical Psychology, Academic Medical Centre, the Netherlands
- Interuniversity Cardiology Institute of the Netherlands, the Netherlands
| | | | - Joost P van Melle
- Department of Cardiology, University Medical Centre Groningen, the Netherlands
| | - Petronella G Pieper
- Department of Cardiology, University Medical Centre Groningen, the Netherlands
| | - Arie PJ van Dijk
- Department of Cardiology, Radboud University Nijmegen Medical Centre, the Netherlands
| | | | | | | | | | | | - Barbara JM Mulder
- Department of Cardiology, Academic Medical Centre, the Netherlands
- Interuniversity Cardiology Institute of the Netherlands, the Netherlands
| |
Collapse
|
10
|
Affiliation(s)
- Mei-Yun Cheng
- Department of NeurologyChang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Ya-Chen Wang
- Merck Limited, Taipei, Taiwan, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Tony Wu
- Department of NeurologyChang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| |
Collapse
|
11
|
Agashivala N, Kim E. Cost-effectiveness of early initiation of fingolimod versus delayed initiation after 1 year of intramuscular interferon beta-1a in patients with multiple sclerosis. Clin Ther 2012; 34:1583-90. [PMID: 22749258 DOI: 10.1016/j.clinthera.2012.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 06/06/2012] [Accepted: 06/14/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fingolimod is a once-daily orally administered disease-modifying therapy (DMT) indicated for treatment of relapsing forms of multiple sclerosis (MS) to reduce the frequency of clinical relapses and delay accumulation of physical disability. In the randomized, double-blind, phase 3 TRANSFORMS trial, 0.5 mg/d oral fingolimod substantially reduced relapse frequency when compared with IM interferon-β1a (IFN-β1a) at 12-months. In a 12-month, double-blind, extension phase of the TRANSFORMS study, patients assigned to receive fingolimod continued to receive the same dosage, whereas patients who originally received IM IFN-β1a were randomized to receive either 0.5 or 1.25 mg/d fingolimod. OBJECTIVE To investigate the cost-effectiveness of initiating fingolimod therapy early versus after 1 year of IFN-β1a therapy using TRANSFORMS study extension data. METHODS A Microsoft Excel-based model was used to calculate the cost per relapse avoided for 2 years with continuous treatment with fingolimod compared with first-year treatment with IM IFN-β1a and second-year treatment with fingolimod. One-way sensitivity analyses were conducted on key input variables to assess their effect on cost per relapse avoided. RESULTS The 2-year relapse rate in the early fingolimod arm was 0.23, and in the delayed fingolimod arm was 0.53. The cost per relapse avoided was $83,125 in the early fingolimod arm versus $103,624 in the delayed fingolimod arm. Results of the sensitivity analyses showed an effect of drug acquisition cost and number of relapses in patients who received no treatment. CONCLUSION Continuous treatment with fingolimod for 2 years resulted in a lower cost per relapse avoided compared with treatment with IM IFN-β1a for the first year and then switching to fingolimod therapy. Thus, delaying fingolimod therapy does not seem to be cost effective.
Collapse
Affiliation(s)
- Neetu Agashivala
- Novartis Pharmaceuticals Corporation, Health Economics & Outcomes Research, One HealthPlaza, East Hanover, NJ 07936-1080, USA.
| | | |
Collapse
|
12
|
Plow M, Cho C, Finlayson M. Utilization of health promotion and wellness services among middle-aged and older adults with multiple sclerosis in the mid-west US. Health Promot Int 2010; 25:318-30. [PMID: 20427373 DOI: 10.1093/heapro/daq023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Routine engagement in healthy behaviors may improve quality of life in older adults with chronic disabling conditions, such as multiple sclerosis (MS). However, older adults with chronic conditions may face many barriers to engaging in healthy behaviors. Health promotion and wellness services may help older adults with chronic conditions engage in healthy behaviors. Thus, the purpose of this study was to identify factors associated with the use of and unmet needs for heath promotion services among middle-aged and older adults with MS. Data from a cross-sectional telephone survey of individuals aging with MS in the mid-west USA were used for this study (n = 1282). A multinomial regression model was used to identify variables associated with the utilization of health promotion services. A logistic regression model was used to identify variables associated with unmet needs for these services. Females (OR = 1.51; CI: 1.13, 2.00), high school graduates (OR = 1.77; CI: 1.34, 2.34) and people who reported no problems with mobility or balance (OR = 1.68; CI: 1.12, 2.51) were more likely to utilize health promotion and wellness services. Factors that increased the likelihood of reporting an unmet need for these services were being female (OR = 2.34; CI: 1.56, 3.51), greater than a high school education (OR = 1.58; CI: 1.14, 2.20), not being married (OR = 1.79; CI: 1.31, 2.43), having inadequate income (OR = 1.83; CI: 1.31, 2.56), experiencing pain (OR = 1.96; CI: 1.34, 2.87) and reporting less ability to do everyday activities now compared with 1 year ago (OR = 2.13; CI: 1.16, 3.92). To avoid widening the health-disparities gap, future research needs to explore strategies that promote utilization of health promotion services among all middle-aged and older adults with MS.
Collapse
Affiliation(s)
- Matthew Plow
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | | | | |
Collapse
|
13
|
Chiao E, Meyer K. Cost effectiveness and budget impact of natalizumab in patients with relapsing multiple sclerosis. Curr Med Res Opin 2009; 25:1445-54. [PMID: 19422279 DOI: 10.1185/03007990902876040] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Disease-modifying therapy (DMT) is the largest single-cost item that contributes to the total per-patient cost of multiple sclerosis (MS), a disabling disorder of the central nervous system. Natalizumab is the most recent DMT to be approved for the treatment of relapsing MS and may be an attractive alternative to interferon beta and glatiramer acetate (GA). OBJECTIVES To determine from the perspective of a United States payer (1) the incremental cost effectiveness of natalizumab compared with other DMTs and (2) the budgetary impact of utilization of natalizumab for the treatment of relapsing MS. METHODS A combined cost effectiveness and budget impact model was developed. Model inputs were drug acquisition costs (wholesale acquisition cost), costs of drug administration and monitoring, costs of treating relapses, anticipated reduction in relapse rates after 2 years of therapy, and estimated market utilization of natalizumab. Outcomes included total 2-year costs of therapy per patient, costs per relapse avoided for each treatment, and overall 2-year costs to the health plan and per member per month (PMPM) costs. Drug acquisition costs are in 2008 US dollars, and all other costs were inflated to 2008 US dollars when necessary. Univariate sensitivity analyses were performed to determine the model inputs with the greatest influence on the cost per relapse avoided for natalizumab. RESULTS The overall 2-year cost of therapy per patient was $72,120 for natalizumab, $56,790 for intramuscular (IM) interferon beta-1a (IFNbeta-1a), $56,773 for IFNbeta-1b, $57,180 for GA, and $58,538 for subcutaneous (SC) IFNbeta-1a. The cost per relapse avoided was lowest for natalizumab at $56,594, followed by $87,791 for IFNbeta-1b, $93,306 for IM IFNbeta-1a, $96,178 for SC IFNbeta-1a, and $103,665 for GA. The incremental cost-effectiveness ratios of natalizumab relative to IM IFNbeta-1a, IFNbeta-1b, GA, and SC IFNbeta-1a were $23,029, $24,452, $20,671, and $20,403 per additional relapse avoided, respectively. An increase in natalizumab utilization to 9% resulted in an increase of approximately $61 760 in total 2-year costs to a hypothetical health plan of 1 million members, or a $0.003 PMPM incremental cost. Univariate sensitivity analyses indicated that the model inputs with the most influence on cost per relapse avoided for natalizumab were the weighted average number of relapses before treatment and the anticipated relative relapse rate reduction. CONCLUSIONS Natalizumab was the most cost-effective therapy as measured by total cost per relapse avoided, not withstanding a higher drug acquisition cost versus other DMTs. Entry of natalizumab to the market is likely to result in a minimal increase in health-plan costs on a PMPM basis. Limitations of the study include the use of a surrogate measure, relapse avoided, as an outcome measure; also, adverse events were not included in the model.
Collapse
|