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Brüggemann F, Gross S, Süße M, Hok P, Strauss S, Ziemssen T, Frahm N, Zettl UK, Grothe M. Polypharmacy in patients with multiple sclerosis and the impact on levels of care and therapy units. Front Neurol 2023; 14:1330066. [PMID: 38187151 PMCID: PMC10768059 DOI: 10.3389/fneur.2023.1330066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Background The aim of this study was to examine the societal costs of polypharmacy in patients with multiple sclerosis (MS). We therefore focused on the association between the number of medications on the level of care (LOC), the German classification of the need for care, and the number of therapy sessions (TTU). Methods In addition to demographic information and medication, 101 MS patients performed the Multiple Sclerosis Health Resource Utilization Survey (MS-HRS). Medications were subdivided into a total number of medications (TD), MS-related medication [MSD, i.e., disease-modifying drugs (DMDs) and symptomatic treatment (SD)], and medication for comorbidities (CDs). Multivariate linear regression models were performed to estimate if the amount of each medication type affects LOC or TTU. Results Polypharmacy appeared in 54 patients at the time of the survey. The relative risk (RR) of LOC 1 increased significantly by 2.46 (p = 0.001) per TD and by 2.55 (p = 0.004) per MSD, but not per CD (RR 1.44; p = 0.092). The effect of RR on MSD was driven by SD (RR 2.2; p = 0.013) but not DMD (RR 2.6; p = 0.4). RR of MSD remained significant for LOC 2 (1.77; p = 0.009) and LOC 3/4 (1.91; p = 0.015), with a strong trend in RR of SD, but not DMD. TTU increased significantly per MSD (p = 0.012), but not per TD (p = 0.081) and CD (p = 0.724). Conclusion The number of MSDs is related to the likelihood of a higher level of care and the number of therapy sessions and is therefore a good indication of the extent of the societal costs.
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Affiliation(s)
- Finn Brüggemann
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Gross
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Marie Süße
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Pavel Hok
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Sebastian Strauss
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Tjalf Ziemssen
- MS Center, Center of Clinical Neuroscience, University Clinic Carl-Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Niklas Frahm
- Department of Neurology, University Medicine Rostock, Rostock, Germany
| | - Uwe K. Zettl
- Department of Neurology, University Medicine Rostock, Rostock, Germany
| | - Matthias Grothe
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
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Garfield K, Thorn JC, Noble S, Husbands S, Hollingworth W. Development of a brief, generic, modular resource-use measure (ModRUM): piloting with patients. BMC Health Serv Res 2023; 23:994. [PMID: 37710265 PMCID: PMC10503201 DOI: 10.1186/s12913-023-10011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 09/08/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Bespoke self-report resource-use measures (RUMs) are commonly developed or adapted for each new randomised controlled trial. Consequently, RUMs lack standardisation and validation is rarely conducted. A new generic RUM, ModRUM, has been developed using a rigorous process, including consultation with health economists and patients. ModRUM includes a concise core healthcare module, designed to be included in all trials, and depth-adding questions, which can replace or be added to core questions as needed. Modules covering other sectors are under development. The aim of this study was to test the acceptability, feasibility, and criterion and construct validity of the healthcare module of ModRUM. METHODS Patients who had a recent appointment at their GP practice were invited to complete ModRUM (core module or core module with depth questions), a characteristics form and the EQ-5D-5L. Acceptability was assessed via response rates and questionnaire completion time. Feasibility was assessed by reviewing issues observed in participants' responses and question completion rates. Construct validity was tested via hypothesis testing and known-group analyses, using Wilcoxon rank-sum and Kruskal-Wallis tests, and a generalised linear model. Criterion validity was tested by comparing ModRUM results with primary care medical records. Sensitivity, specificity, and agreement using Lin's concordance correlation coefficient (pc) were estimated. RESULTS One hundred patients participated from five GP practices in the South-West of England. Acceptability was higher for the core module (20% versus 10% response rate). Question completion rates were high across both versions (> 90%). Some support was observed for construct validity, with results suggesting that healthcare costs differ dependent on the number of long-term conditions (p < 0.05) and are negatively associated with health-related quality of life (p < 0.01). Sensitivity was high for all questions (> 0.83), while specificity varied (0.33-0.88). There was a good level of agreement for GP contacts and costs, and prescribed medication costs (pc > 0.6). CONCLUSION This study provided preliminary evidence of the acceptability, feasibility, and criterion and construct validity of ModRUM. Further testing is required within trials and with groups that were less well represented in this study.
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Affiliation(s)
- Kirsty Garfield
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whitladies Road, Bristol, BS8 1NU, UK.
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK.
| | - Joanna C Thorn
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whitladies Road, Bristol, BS8 1NU, UK
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
| | - Sian Noble
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whitladies Road, Bristol, BS8 1NU, UK
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
| | - Samantha Husbands
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whitladies Road, Bristol, BS8 1NU, UK
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
| | - Will Hollingworth
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whitladies Road, Bristol, BS8 1NU, UK
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
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Data Resource Profile: The Multiple Sclerosis Documentation System 3D and AOK PLUS Linked Database (MSDS-AOK PLUS). J Clin Med 2023; 12:jcm12041441. [PMID: 36835976 PMCID: PMC9962623 DOI: 10.3390/jcm12041441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Real-world evidence in multiple sclerosis (MS) is limited by the availability of data elements in individual real-world datasets. We introduce a novel, growing database which links administrative claims and medical records from an MS patient management system, allowing for the complete capture of patient profiles. Using the AOK PLUS sickness fund and the Multiple Sclerosis Documentation System MSDS3D from the Center of Clinical Neuroscience (ZKN) in Germany, a linked MS-specific database was developed (MSDS-AOK PLUS). Patients treated at ZKN and insured by AOK PLUS were recruited and asked for informed consent. For linkage, insurance IDs were mapped to registry IDs. After the deletion of insurance IDs, an anonymized dataset was provided to a university-affiliate, IPAM e.V., for further research applications. The dataset combines a complete record of patient diagnoses, treatment, healthcare resource use, and costs (AOK PLUS), with detailed clinical parameters including functional performance and patient-reported outcomes (MSDS3D). The dataset currently captures 500 patients; however, is actively expanding. To demonstrate its potential, we present a use case describing characteristics, treatment, resource use, and costs of a patient subsample. By linking administrative claims to clinical information in medical charts, the novel MSDS-AOK PLUS database can increase the quality and scope of real-world studies in MS.
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Ziemssen T, Bhan V, Chataway J, Chitnis T, Campbell Cree BA, Havrdova EK, Kappos L, Labauge P, Miller A, Nakahara J, Oreja-Guevara C, Palace J, Singer B, Trojano M, Patil A, Rauser B, Hach T. Secondary Progressive Multiple Sclerosis. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2023; 10:10/1/e200064. [DOI: 10.1212/nxi.0000000000200064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022]
Abstract
Many challenges exist in the precise diagnosis and clinical management of secondary progressive multiple sclerosis (SPMS) because of the lack of definitive clinical, imaging, immunologic, or pathologic criteria that demarcate the transition from relapsing-remitting MS to SPMS. This review provides an overview of the diagnostic criteria/definition and the heterogeneity associated with different SPMS patient populations; it also emphasizes the importance of available prospective/retrospective tools to identify patients with SPMS earlier in the disease course so that approved disease-modifying therapies and nonpharmacological strategies will translate into better outcomes. Delivery of such interventions necessitates an evolving patient-clinician dialog within the context of a multidisciplinary team.
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Test-Retest of the Cost for Patients Questionnaire. Int J Technol Assess Health Care 2022; 38:e65. [PMID: 35811410 DOI: 10.1017/s0266462322000460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ziemssen T, Richter S, Mäurer M, Buttmann M, Kreusel B, Poehler AM, Lampl M, Linker RA. OzEAN Study to Collect Real-World Evidence of Persistent Use, Effectiveness, and Safety of Ozanimod Over 5 Years in Patients With Relapsing-Remitting Multiple Sclerosis in Germany. Front Neurol 2022; 13:913616. [PMID: 35832177 PMCID: PMC9271678 DOI: 10.3389/fneur.2022.913616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background:Ozanimod, a sphingosine 1-phosphate receptor 1 and 5 modulator, was approved as a disease-modifying therapy for active relapsing-remitting multiple sclerosis (RRMS) in 2020 and for active ulcerative colitis in 2021. Long-term, real-world studies in a nonselective population are needed. OzEAN is an ongoing study to assess the real-world persistent use, effectiveness, and safety of ozanimod and its impact on quality of life (QoL) in patients with RRMS over a 5-year period.MethodsThis prospective, noninterventional, postmarketing authorization study will enroll ~1,300 patients (≥18 years of age) with active RRMS. The decision to initiate ozanimod must have been made before and independent from study participation. Enrollment began in March 2021. Recruitment is ongoing and will last for 36 months across 140 sites in Germany. Treatment-naive patients or those having prior experience with a disease-modifying therapy receive oral ozanimod 0.92 mg/day after an initial dose escalation, per the summary of product characteristics recommendations, for up to 60 months. Persistence with ozanimod treatment (primary endpoint) is assessed at month 60. Secondary endpoints include additional physician-reported outcomes [persistence at earlier time points, annualized relapse rate, Expanded Disability Status Scale score, cognition (Symbol Digit Modalities Test), and incidence of adverse events], and patient-reported outcomes assessing patient satisfaction, adherence, and treatment modalities (Treatment Satisfaction Questionnaire for Medication, v1.4), disability (United Kingdom Neurological Disability Rating Scale), QoL (MSQOL-54 questionnaire), fatigue (Fatigue Scale for Motor and Cognitive Functions), and health economics [Work Productivity and Activity Impairment Questionnaire for Multiple Sclerosis (German v2.1); Multiple Sclerosis Health Resource Survey, v3.0]. A Multiple Sclerosis Documentation System with an internet-based e-health portal allows patients to view files and complete questionnaires. A safety follow-up will occur 3–8 months after the last ozanimod dose for patients who discontinue treatment early. Long-term results are anticipated after study completion in 2029. Yearly interim analyses are planned after enrollment has reached 25%.ConclusionThis is the first long-term, real-world study of ozanimod in patients with RRMS and, to our knowledge, the first noninterventional study utilizing a patient portal. These data will add to the safety/efficacy profile of ozanimod demonstrated in phase 3 trials.Clinical Trial RegistrationClinicaltrials.gov, identifier: NCT05335031.
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Affiliation(s)
- Tjalf Ziemssen
- Department of Neurology, Center of Clinical Neuroscience, Carl Gustav Carus University Clinic, University Hospital of Dresden, Dresden, Germany
- *Correspondence: Tjalf Ziemssen
| | | | - Mathias Mäurer
- Department of Neurology, Klinikum Würzburg Mitte, Würzburg, Germany
| | - Mathias Buttmann
- Department of Neurology, Caritas Hospital Bad Mergentheim, Bad Mergentheim, Germany
| | - Boris Kreusel
- Bristol Myers Squibb GmbH & Co. KGaA, Munich, Germany
| | | | - Maren Lampl
- Bristol Myers Squibb GmbH & Co. KGaA, Munich, Germany
| | - Ralf A. Linker
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
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Koeditz D, Frensch J, Bierbaum M, Ness NH, Ettle B, Vudumula U, Gudala K, Adlard N, Tiwari S, Ziemssen T. Comparing the long-term clinical and economic impact of ofatumumab versus dimethyl fumarate and glatiramer acetate in patients with relapsing multiple sclerosis: A cost-consequence analysis from a societal perspective in Germany. Mult Scler J Exp Transl Clin 2022; 8:20552173221085741. [PMID: 35371535 PMCID: PMC8969034 DOI: 10.1177/20552173221085741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/21/2022] [Accepted: 02/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Evidence suggests that early highly efficacious therapy in relapsing multiple sclerosis is superior to escalation strategies. Objective A cost-consequence analysis simulated different treatment scenarios with ofatumumab (OMB), dimethyl fumarate (DMF) and glatiramer acetate (GA): immediate OMB initiation as first treatment, early switch to OMB after 1 year on DMF/GA, late switch after 5 years or no switch. Methods An EDSS-based Markov model with a 10-year time horizon was applied. Cycle transitions included EDSS progression, improvement or stabilization, treatment discontinuation, relapse or death. Input data were extracted from OMB trials, a network meta-analysis, published literature, and publicly available sources. Results The late switch compared to the immediate OMB scenario resulted in a lower proportion of patients with EDSS 0-3 (Δ - 7.5% DMF; Δ - 10.3% GA), more relapses (Δ + 0.72 DMF; Δ + 1.23 GA) and lower employment rates (Δ - 4.0% DMF; Δ - 5.6% GA). The same applies to late versus early switches. No switch scenarios resulted in worse outcomes. Higher drug acquisition costs in the immediate OMB and early switch scenarios were almost compensated by lower costs for patient care and productivity loss. Conclusion Immediate OMB treatment and an early switch improves clinical and productivity outcomes while remaining almost cost neutral compared to late or no switches.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tjalf Ziemssen
- Zentrum für klinische Neurowissenschaften, Universitaetsklinikum Carl Gustav Carus Dresden, Dresden, Germany
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Krüger K, Fricke LM, Dilger EM, Thiele A, Schaubert K, Hoekstra D, Heidenreich F, Brütt AL, Stahmeyer JT, Stahmann A, Röper AL, Kubiak KP, Hemmerling M, Grau A, Eichstädt K, Behrens S, Krauth C. How is and how should healthcare for people with multiple sclerosis in Germany be designed?-The rationale and protocol for the mixed-methods study Multiple Sclerosis-Patient-Oriented Care in Lower Saxony (MS-PoV). PLoS One 2021; 16:e0259855. [PMID: 34762697 PMCID: PMC8584984 DOI: 10.1371/journal.pone.0259855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common autoimmune inflammatory disease of the central nervous system in Europe, often causing severe physical, cognitive and emotional impairments. Currently, it is unclear whether the healthcare provisions of people with MS (PwMS) are in line with the recommendations for treatment based on guidelines or patients' needs. The main objectives of the study are as follows: (a) to investigate how well PwMS are treated; and (b) to develop a needs-oriented, patient-centred care model. METHODS This mixed-methods study focuses on adult PwMS living in Lower Saxony, a federal state in Germany. The qualitative study comprises focus groups with PwMS, physicians and people involved in the healthcare process as well as a future workshop. The quantitative study comprises a cross-sectional online survey and addresses the patient-relevant outcomes and needs, as previously determined by literature searches and focus groups. It will be administered to all PwMS who are insured by the statutory health insurance company involved in the project (n~7,000). The survey data will be linked to the longitudinal secondary data from the statutory health insurance company and data from the German MS registry where available. The linked and single data sources will be statistically analysed. DISCUSSION By comprehensively comparing the current healthcare provisions with the needs and requirements of PwMS, the strengths and weaknesses of the overall healthcare process and provision of assistive devices can be identified. The barriers and facilitators of the health service providers and their impact on daily life will be explored (qualitative analyses). Reliable recommendations for improvements will be given based on a study population drawn from the largest statutory health insurance company in Lower Saxony (quantitative analyses). However, the inherent advantages and limitations of the qualitative and quantitative research approaches need to be considered. TRIAL REGISTRATION The study is registered at German Clinical Trials Register DRKS00021741.
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Affiliation(s)
- Kathrin Krüger
- Institute for Epidemiology, Social Medicine, and Health Systems Research, Hannover Medical School (MHH), Hannover, Germany
- Center for Health Economics Research (CHERH), Hannover, Germany
| | - Lara Marleen Fricke
- Institute for Epidemiology, Social Medicine, and Health Systems Research, Hannover Medical School (MHH), Hannover, Germany
- Center for Health Economics Research (CHERH), Hannover, Germany
| | - Elise-Marie Dilger
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Annett Thiele
- Institut für Sonder- und Rehabilitationspädagogik, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Kristina Schaubert
- Institute for Epidemiology, Social Medicine, and Health Systems Research, Hannover Medical School (MHH), Hannover, Germany
- Center for Health Economics Research (CHERH), Hannover, Germany
| | - Dyon Hoekstra
- Institut für Sonder- und Rehabilitationspädagogik, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Fedor Heidenreich
- Klinik für Neurologie und klinische Neurophysiologie, DIAKOVERE Henriettenstift, Hannover, Germany
- Deutsche Multiple Sklerose Gesellschaft (DMSG) Landesverband Niedersachsen e.V., Hannover, Germany
| | - Anna Levke Brütt
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | | | | | - Anna-Lena Röper
- MS Forschungs- und Projektentwicklungs-gGmbH, Hannover, Germany
| | - Klaus-Peter Kubiak
- Deutsche Multiple Sklerose Gesellschaft (DMSG) Landesverband Niedersachsen e.V., Hannover, Germany
| | | | - Anja Grau
- Deutsche Multiple Sklerose Gesellschaft (DMSG) Landesverband Niedersachsen e.V., Hannover, Germany
| | | | - Sabine Behrens
- Deutsche Multiple Sklerose Gesellschaft (DMSG) Landesverband Niedersachsen e.V., Hannover, Germany
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine, and Health Systems Research, Hannover Medical School (MHH), Hannover, Germany
- Center for Health Economics Research (CHERH), Hannover, Germany
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Schriefer D, Haase R, Ness NH, Ziemssen T. Cost of illness in multiple sclerosis by disease characteristics - A review of reviews. Expert Rev Pharmacoecon Outcomes Res 2021; 22:177-195. [PMID: 34582300 DOI: 10.1080/14737167.2022.1987218] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: In light of the increasing number of economic burden studies and heterogeneity in methodology and reporting standards, there is a need for robust evidence synthesis on an umbrella review level.Areas covered: We performed the first review of reviews of cost-of-illness studies in multiple sclerosis. Focusing on disaggregated costs by disease characteristics (disability level, relapse, disease course), we also characterized the underlying methodological evidence base of individual (primary) studies.Expert Commentary: We identified 17 reviews encompassing 111 unique primary studies, and a high degree of overlap across reviews. Costs were substantial, rising with disability level, relapse episodes, and disease progression. Disability was the key cost driver. Compared to mild disability, total costs for moderate disability were 1.4-2.3-fold higher and 1.8-2.9-fold higher for severe disability. With escalating disability, the share of costs outside the health system (indirect costs, informal care) increasingly outweighed the share of direct medical costs. Of all 111 primary studies, 72% gathered resource use/loss data by patient self-report. Associated costs were mostly reported by disability level (75%), followed by relapse (48%) and disease course (21%). In conclusion, although heterogeneity can make in-depth comparisons of costs across studies impossible, important patterns are broadly apparent.
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Affiliation(s)
- Dirk Schriefer
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Rocco Haase
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
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Ness NH, Schriefer D, Haase R, Ziemssen T. [The Multiple Sclerosis Health Resource Utilization Survey]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 90:42-48. [PMID: 34005824 DOI: 10.1055/a-1471-3636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND In health economic studies, valid and reliable cost data are essential to reach meaningful conclusions. In the case of multiple sclerosis (MS), such studies are often based on primary data for which the underlying survey instruments have not been published. In addition, heterogeneous methods make the comparability and interpretation of such study results difficult. To standardize health economic studies in MS, the Multiple Sclerosis Health Resource Utilization Survey (MS-HRS) was developed, validated and published in a freely accessible format. RESEARCH QUESTION This review focuses on the MS-HRS. We report on the methodological background of studies on the assessment of cost of illness as well as MS-HRS-based results on the costs of disease dynamics in people with MS. METHODS This article is based on a selective literature review on the MS-HRS as well as on health economic aspects of cost assessment. RESULTS The MS-HRS provides a holistic assessment of direct medical, direct non-medical and indirect resource utilization. Within indirect costs, we considered absenteeism, either short term (sick leave) or long term (disability pension), but also presenteeism, which refers to impaired performance during work. Resources were valued at the societal opportunity cost or the best possible approximation. First analyses based on MS-HRS showed that, in addition to inpatient disease severity and clinical course, disease dynamics in form of relapses and progression have enormous socioeconomic implications. CONCLUSION Valid cost data bring transparency to the economic consequences of diseases. In addition to clinical data, cost data can be used to determine cost-effectiveness and thus reveal opportunities for more efficient patient care. For the case of MS, a freely accessible tool is available for cost assessments.
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Affiliation(s)
| | - Dirk Schriefer
- MS Center, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Deutschland
| | - Rocco Haase
- MS Center, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Deutschland
| | - Tjalf Ziemssen
- MS Center, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Deutschland
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Electronic Health Interventions in the Case of Multiple Sclerosis: From Theory to Practice. Brain Sci 2021; 11:brainsci11020180. [PMID: 33540640 PMCID: PMC7913051 DOI: 10.3390/brainsci11020180] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
(1) Background: eHealth interventions play a growing role in shaping the future healthcare system. The integration of eHealth interventions can enhance the efficiency and quality of patient management and optimize the course of treatment for chronically ill patients. In this integrative review, we discuss different types of interventions, standards and advantages of quality eHealth approaches especially for people with multiple sclerosis (pwMS). (2) Methods: The electronic databases PubMed, Cochrane and Web of Science were searched to identify potential articles for eHealth interventions in pwMS; based on 62 articles, we consider different ways of implementing health information technology with various designs. (3) Results: There already exist some eHealth interventions for single users with a single-use case, interventions with a social setting, as well as eHealth interventions that integrate various single and social interventions and even those that may be used additionally for complex use cases. A key determinant of consumer acceptance is a high-quality user-centric design for healthcare practitioners and pwMS. In pwMS, the different neurological disabilities should be considered, and particular attention must be paid to the course of the treatment and the safety processes of each treatment option. (4) Conclusion: Depending on the field of application and the respective users, interventions are designed for single, social, integrated or complex use. In order to be accepted by their target group, interventions must be beneficial and easy to use.
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Schriefer D, Ness NH, Haase R, Ziemssen T. Gender disparities in health resource utilization in patients with relapsing-remitting multiple sclerosis: a prospective longitudinal real-world study with more than 2000 patients. Ther Adv Neurol Disord 2020; 13:1756286420960274. [PMID: 33178335 PMCID: PMC7592171 DOI: 10.1177/1756286420960274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/25/2020] [Indexed: 12/16/2022] Open
Abstract
Background: For the case of multiple sclerosis, research on gender differences from a
health economics perspective has not received much attention. However,
cost-of-illness analyses can provide valuable information about the diverse
impact of the disease and thus help decision-makers to allocate scarce
resources. The aim of this study was to describe healthcare resource use and
associated societal costs from a gender perspective. In particular, we aimed
to identify how resource utilization potentially differs in certain cost
components between men and women. Methods: Clinical and economic data were extracted from two prospective, multicentre,
non-interventional, observational studies in Germany. Information on health
resource use was obtained from all patients on a quarterly basis using a
validated questionnaire. Cost analyses were conducted from the societal perspective including all
direct (healthcare-related) and indirect (work-related) costs, regardless of
who bears them. Gender-related differences were analysed by a multivariable
generalized linear model with a negative binomial distribution and log link
function due to the right-skewed distribution pattern of cost data. In
addition, costs for men and women were descriptively analysed within
subgroups of two-year disease activity. Results: In total, 2095 patients (women-to-men ratio of 2.7:1) presented a mean age of
41.85 years and a median Expanded Disability Status Scale of 2
(interquartile range 1–3.5) (p > 0.30 for gender-related
differences). Women and men did not statistically differ in total quarterly
costs (€2329 ± €2570 versus €2361 ± €2612). For both, costs
were higher with advancing disease severity and indirect costs were the main
societal cost driver. Regarding healthcare-related resources, women incurred
higher costs for ambulant consultations [incidence rate ratio (IRR) 1.16,
confidence interval (CI) 1.04–1.31], complementary medicine (IRR 2.41, CI
1.14–5.06), medical consumables (IRR 2.53, CI 1.69–3.79) and informal care
(IRR 2.79, CI 1.56–5.01). Among indirect costs, we found higher costs for
men for presenteeism (IRR 0.62; CI 0.53–0.72) and higher costs for women for
disability pension (IRR 1.62; CI 1.23–2.13). Conclusions: Multiple sclerosis poses a significant economic burden on patients, families
and society. While the total economic burden did not differ between male and
female patients, we found gender differences in specific cost items that are
similar to those in the wider non-MS population.
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Affiliation(s)
- Dirk Schriefer
- MS Center Dresden, Center of Clinical Neuroscience, Neurological University Clinic Dresden, Germany
| | - Nils-Henning Ness
- MS Center Dresden, Center of Clinical Neuroscience, Neurological University Clinic Dresden, Germany
| | - Rocco Haase
- MS Center Dresden, Center of Clinical Neuroscience, Neurological University Clinic Dresden, Germany
| | - Tjalf Ziemssen
- Department of Neurology, MS Center Dresden, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Fetscherstr. 74, Dresden, 01307, Germany
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13
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Schriefer D, Haase R, Ettle B, Ziemssen T. Patient- versus physician-reported relapses in multiple sclerosis: insights from a large observational study. Eur J Neurol 2020; 27:2531-2538. [PMID: 32643851 DOI: 10.1111/ene.14432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE The patient's perspective is becoming increasingly important for endpoints in studies on multiple sclerosis. However, relapse data generated from the patient's perspective in combination with independent documentation by the physician are scarce. Our objective was to compare self-reported relapses by the patient to physician-documented relapses within a routine clinical practice setting of quarterly visits. METHODS Two-year data (n = 1921 patients) were extracted from two prospective, non-interventional, multicentre cohort studies in Germany. The number of relapses independently reported by patients and physicians was analysed. In addition, inter-rater reliability and measures of validity were evaluated. Patterns of associations were investigated in subgroup analysis of sociodemographic, clinical and patient-reported outcome measures. RESULTS Patients and physicians showed good overall agreement [κ = 0.78, 95% confidence interval (CI) 0.76-0.80]. Nevertheless, patients reported, on average, more relapses than physicians during follow-up (0.55 vs. 0.44; P < 0.001). Corresponding annualized relapse rates were 0.38 (95% CI 0.36-0.39) and 0.30 (95% CI 0.29-0.31), respectively. Differences between physicians and patients were particularly pronounced in patient groups with greater disability levels, decreased health-related quality of life or treatment satisfaction. The positive predictive value was 74.01% (95% CI 71.85-76.07), and the negative predictive value was 98.86% (95% CI 98.67-99.03). CONCLUSION Some disagreement on the occurrence of relapses appears in specific patient subgroups, where factors such as pseudo-relapses or confounding factors may have promoted over- or under-reporting.
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Affiliation(s)
- D Schriefer
- Centre of Clinical Neuroscience, Neurological University Clinic Dresden, Dresden, Germany
| | - R Haase
- Centre of Clinical Neuroscience, Neurological University Clinic Dresden, Dresden, Germany
| | - B Ettle
- Novartis Pharma GmbH, Nuremberg, Germany
| | - T Ziemssen
- Centre of Clinical Neuroscience, Neurological University Clinic Dresden, Dresden, Germany
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14
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Ness NH, Schriefer D, Haase R, Ettle B, Ziemssen T. Real-World Evidence on the Societal Economic Relapse Costs in Patients with Multiple Sclerosis. PHARMACOECONOMICS 2020; 38:883-892. [PMID: 32363542 DOI: 10.1007/s40273-020-00917-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Relapses are the hallmark of multiple sclerosis (MS). Analyses have shown that the cost of MS increases during periods of relapse. However, results are inconsistent between studies, possibly due to different study designs and the different implications of relapses with respect to patient characteristics. OBJECTIVES The aims were to estimate and describe direct and indirect relapse costs and to determine differences in costs with respect to patient characteristics. Furthermore, we describe the pharmacoeconomic impact during the relapse follow-up. METHODS Data were extracted from two German, multicenter, observational studies applying a validated resource costs instrument. Relapse costs were calculated as the difference in quarterly costs between propensity score (PS)-matched patients with and without relapses (1:1 ratio). For relapse active patients, we additionally calculated the difference between quarterly costs prior to and during relapse and determined costs in the post-relapse quarter. RESULTS Of 1882 patients, 607 (32%) presented at least one relapse. After PS-matching, 597 relapse active and relapse inactive patients were retained. Relapse costs (in 2019 values) ranged between €791 (age 50 + years) and €1910 (disease duration < 5 years). In mildly disabled and recently diagnosed patients, indirect relapse costs (range €1073-€1207) constantly outweighed direct costs (range €591-€703). The increase from prior quarter to relapse quarter was strongest for inpatient stays (+ 366%, €432; p < 0.001), day admissions (+ 228%, €57; p < 0.001), and absenteeism (127%, €463; p < 0.001). In the post-relapse quarter, direct costs and costs of absenteeism remained elevated for patients with relapse-associated worsening. CONCLUSION A recent diagnosis and mild disability lead to high relapse costs. The results suggest the necessity to incorporate patient characteristics when assessing relapse costs.
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Affiliation(s)
- Nils-Henning Ness
- MS Center, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany
| | - Dirk Schriefer
- MS Center, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany
| | - Rocco Haase
- MS Center, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany
| | | | - Tjalf Ziemssen
- MS Center, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany.
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15
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Ziemssen T, Hoffmann O, Klotz L, Schreiber H, Weber MS, Rauser B. Gaining First Insights on Secondary Progressive Multiple Sclerosis Patients Treated With Siponimod in Clinical Routine: Protocol of the Noninterventional Study AMASIA. JMIR Res Protoc 2020; 9:e19598. [PMID: 32499214 PMCID: PMC7414415 DOI: 10.2196/19598] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 12/19/2022] Open
Abstract
Background A high proportion of patients with relapsing remitting multiple sclerosis convert to secondary progressive multiple sclerosis (SPMS) characterized by irreversibly progressing disability and cognitive decline. Siponimod (Mayzent), a selective sphingosine-1-phosphate receptor modulator, was recently approved by the European Medicines Agency for the treatment of adult SPMS patients with active disease, as evidenced by relapses or magnetic resonance imaging features of ongoing inflammatory activity. Approval by the Food and Drug Administration covers a broader range of indications, comprising clinically isolated syndrome, relapsing remitting multiple sclerosis, and active SPMS. However, treatment effects of siponimod have not been assessed in a structured setting in clinical routine so far. Objective The objectives of AMASIA (impAct of Mayzent [siponimod] on secondAry progressive multiple Sclerosis patients in a long-term non-Interventional study in GermAny), a prospective noninterventional study, are to assess the long-term effectiveness and safety of siponimod in clinical routine and to evaluate the impact of disease burden on quality of life and socioeconomic conditions. Here, we report the study design of AMASIA. Methods Treatment effects of siponimod will be evaluated in 1500 SPMS patients during a 3-year observational phase. According to the genetic polymorphism of CYP2C9, the initial dose will be titrated to the maintenance dose of 1 mg (CYP2C9*1*3 and *2*3) or 2 mg (all other polymorphisms of CYP2C9 except *3*3, which is contraindicated) taken orally once daily. Primary endpoint is the 6-month confirmed disability progression, as assessed by a functional composite endpoint comprising the Expanded Disability Status Scale and symbol digit modalities test to take appropriate account of cognitive changes and increase sensitivity. Further measures including multiple sclerosis activity data; assessments of functional domains; questionnaires addressing the patients’, physicians’, and relatives’ perspectives of disability progression; cognitive worsening; quality of life; and socioeconomic aspects will be documented using the multiple sclerosis documentation system MSDS3D. Results AMASIA is being conducted between February 2020 and February 2025 in up to 250 neurological centers in Germany. Conclusions AMASIA will complement the pivotal phase III–derived efficacy and safety profile of siponimod with real-world data and will further evaluate several individual treatment aspects such as quality of life and socioeconomic conditions of patients and caregivers. It might help to establish siponimod as a promising option for the treatment of SPMS patients in clinical routine. International Registered Report Identifier (IRRID) DERR1-10.2196/19598
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Affiliation(s)
- Tjalf Ziemssen
- Department of Neurology, Center of Clinical Neuroscience, Carl Gustav Carus University Clinic, University Hospital of Dresden, Dresden, Germany
| | - Olaf Hoffmann
- Department of Neurology, St Josefs-Krankenhaus, Potsdam, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Herbert Schreiber
- Neurological Practice Center, NTD & Neuropoint Academy, Ulm, Germany
| | - Martin S Weber
- Institute of Neuropathology, University Medical Center Goettingen, Goettingen, Germany.,Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
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16
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Ziemssen T, Kern R, Voigt I, Haase R. Data Collection in Multiple Sclerosis: The MSDS Approach. Front Neurol 2020; 11:445. [PMID: 32612566 PMCID: PMC7308591 DOI: 10.3389/fneur.2020.00445] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/27/2020] [Indexed: 01/17/2023] Open
Abstract
Multiple sclerosis (MS) is a frequent chronic inflammatory disease of the central nervous system that affects patients over decades. As the monitoring and treatment of MS become more personalized and complex, the individual assessment and collection of different parameters ranging from clinical assessments via laboratory and imaging data to patient-reported data become increasingly important for innovative patient management in MS. These aspects predestine electronic data processing for use in MS documentation. Such technologies enable the rapid exchange of health information between patients, practitioners, and caregivers, regardless of time and location. In this perspective paper, we present our digital strategy from Dresden, where we are developing the Multiple Sclerosis Documentation System (MSDS) into an eHealth platform that can be used for multiple purposes. Various use cases are presented that implement this software platform and offer an important perspective for the innovative digital patient management in the future. A holistic patient management of the MS, electronically supported by clinical pathways, will have an important impact on other areas of patient care, such as neurorehabilitation.
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Affiliation(s)
- Tjalf Ziemssen
- Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Isabel Voigt
- Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Rocco Haase
- Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden, Germany
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17
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Voigt I, Benedict M, Susky M, Scheplitz T, Frankowitz S, Kern R, Müller O, Schlieter H, Ziemssen T. A Digital Patient Portal for Patients With Multiple Sclerosis. Front Neurol 2020; 11:400. [PMID: 32670174 PMCID: PMC7326091 DOI: 10.3389/fneur.2020.00400] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/17/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Multiple Sclerosis is a chronic inflammatory disease of the central nervous system that requires a complex, differential, and lifelong treatment strategy, which involves high monitoring efforts and the accumulation of numerous medical data. A fast and broad availability of care, as well as patient-relevant data and a stronger integration of patients and participating care providers into the complex treatment process is desirable. The aim of the ERDF-funded project "Integrated Care Portal Multiple Sclerosis" (IBMS) was to develop a pathway-based care model and a corresponding patient portal for MS patients and health care professionals (HCPs) as a digital tool to deliver the care model. Methods: The patient portal was created according to a patient-centered design approach which involves both the patients' and the professionals' view. Buurmann's five iterative phases were integrated into a design science research process. A problem analysis focusing on functions and user interfaces was conducted through surveys and workshops with MS patients and HCPs. Based on this, the patient portal was refined and a prototype of the portal was implemented using an agile software development strategy. Results: HCPs and patients already use digital hardware and are open to new technologies. Nevertheless, they desire improved (digital) communication and coordination between care providers. Both groups require a number of functions for the patient portal, which were implemented in the prototype. Usability tests with patients and HCPs are planned to consider whether the portal is deemed as usable, acceptable as well as functional to prepare for any needed ameliorations. Discussion: After testing the patient portal for usability, acceptability, and functionality, it will most likely be a useful and high-quality electronic health (eHealth) tool for patient management from day care to telerehabilitation. It implements clinical pathways in a manner which is comprehensible for patients. Future developments of the patient portal modules could include additional diseases, the integration of quality management and privacy management tools, and the use of artificial intelligence to personalize treatment strategies.
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Affiliation(s)
- Isabel Voigt
- Department of Neurology, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Martin Benedict
- Chair of Wirtschaftsinformatik, Especially Systems Development, Faculty of Business and Economics, Technical University of Dresden, Dresden, Germany
| | - Marcel Susky
- Chair of Wirtschaftsinformatik, Especially Systems Development, Faculty of Business and Economics, Technical University of Dresden, Dresden, Germany
| | - Tim Scheplitz
- Chair of Wirtschaftsinformatik, Especially Systems Development, Faculty of Business and Economics, Technical University of Dresden, Dresden, Germany
| | | | | | | | - Hannes Schlieter
- Chair of Wirtschaftsinformatik, Especially Systems Development, Faculty of Business and Economics, Technical University of Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- Department of Neurology, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
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