Asche Carl V, Singer Mendel E, Jhaveri Mehul, Chung Hsingwen, Miller Aaron
Department of Pharmacotherapy, University of Utah, Salt Lake City, UT 84108, USA.
J Manag Care Pharm. 2010 Nov-Dec;16(9):703-12. doi: 10.18553/jmcp.2010.16.9.703.
Multiple sclerosis (MS) is a costly and crippling neurologic disease. Approximately 250,000 to 400,000 persons in the United States are currently diagnosed with MS. Most individuals experience their first symptoms between the ages of 20 and 40 years; therefore, this disease may have substantial impact over many years of life on health, quality of life, productivity, and employment. Whereas a number of studies have utilized a cross-sectional design to evaluate the costs associated with MS, no study has used a large administrative claims database to analyze the direct costs associated with newly diagnosed MS.
To estimate the additional health care utilization and costs in otherwise healthy patients with newly diagnosed MS.
This was a retrospective cohort analysis of the Medstat MarketScan Commercial Claims and Encounters database, which is composed of medical and pharmacy claims for approximately 8 million beneficiaries from 45 U.S. commercial health plans. Cases extracted from the database included adults aged 18 to 64 years with either (a) at least 2 medical claims with a diagnosis of MS (ICD-9-CM code 340) in any diagnosis field on the claim or (b) 1 prescription (medical or pharmacy) claim for injectable MS drug therapy (interferon beta-1a, interferon beta- 1b, glatiramer acetate) for dates of service between January 1, 2004, and December 31, 2006. Natalizumab was not used to identify MS cases, but was used to exclude potential comparison group subjects. The index date for patients with MS was the first qualifying diagnosis or pharmacy claim. Each MS patient was matched to 5 "healthy comparison" cases without MS diagnoses or treatment using the following variables: region, insurance type, gender, relation to employee, age, and enrollment period. Cases with any condition listed in the Charlson Comorbidity Index were excluded from both the MS and "healthy comparison" cohorts. Each "healthy comparison" case was assigned the index date of the matching MS patient. Continuous enrollment 12 months pre- and post-index was required for both the MS and "healthy comparison" groups. Costs broken down by type of utilization were adjusted to 2010 dollars using the appropriate medical component of the Consumer Price Index. Use of services and costs were compared using chi-square, t-tests, parametric and nonparametric tests.
1,411 MS cases (65.6% female) were matched to 7,055 "healthy comparison" cases (65.6% female). In the analyses of all-cause health care services during the 12-month post-index period, MS patients were significantly more likely to use all categories of health services examined. Compared with the "healthy comparison" group, new MS patients were 3.5 times as likely to be hospitalized (15.2% vs. 4.3% for MS vs. comparison, respectively), twice as likely to have at least 1 emergency room (ER) visit (25.5% vs. 12.2%) and 2.4 times as likely to have at least 1 visit for physical, occupational, or speech therapy (23.7% vs. 9.9%; P < 0.001 for all comparisons). MS patients also had higher mean 12-month costs related to each category of service (inpatient services $4,110 vs. $836; radiology services $1,693 vs. $259; ER $432 vs. $189; office visits $849 vs. $310; therapies $295 vs. $81, respectively; all P values < 0.001). Total mean 12-month all-cause health care costs were significantly higher for MS patients than for the "healthy comparison" group ($18,829 vs. $4,038, respectively, P < 0.001). Claims attributed to MS by diagnosis code in any field on the claim or use of an MS injectable drug accounted for a mean cost of $8,839 (46.9%), and MS injectable drugs accounted for $4,573 (24.3%) of total all-cause health care costs.
Newly diagnosed MS patients have significantly higher rates of hospitalizations, radiology services, and ER and outpatient visits compared with non-MS "healthy comparison" patients. MS presents a considerable burden to the U.S. health care system within the first year of diagnosis.
多发性硬化症（MS）是一种代价高昂且使人致残的神经系统疾病。目前美国约有25万至40万人被诊断患有MS。大多数人在20至40岁之间出现首次症状；因此，这种疾病可能在多年的生活中对健康、生活质量、生产力和就业产生重大影响。尽管有多项研究采用横断面设计来评估与MS相关的成本，但尚无研究使用大型行政索赔数据库来分析新诊断MS患者的直接成本。
估计新诊断的MS患者在其他方面健康的情况下额外的医疗保健利用情况和成本。
这是一项对Medstat MarketScan商业索赔和就诊数据库的回顾性队列分析，该数据库由来自45个美国商业健康计划的约800万受益人的医疗和药房索赔组成。从数据库中提取的病例包括18至64岁的成年人，他们满足以下条件之一：（a）在索赔的任何诊断字段中至少有2次诊断为MS（国际疾病分类第九版临床修订本代码340）的医疗索赔，或（b）在2004年1月1日至2006年12月31日的服务日期内有1次注射用MS药物治疗（干扰素β-1a、干扰素β-1b、醋酸格拉替雷）的处方（医疗或药房）索赔。纳他珠单抗未用于识别MS病例，但用于排除潜在的对照组受试者。MS患者的索引日期是首次符合条件的诊断或药房索赔日期。使用以下变量将每位MS患者与5名无MS诊断或治疗的“健康对照”病例进行匹配：地区、保险类型、性别、与员工的关系、年龄和参保期。患有Charlson合并症指数中列出的任何疾病的病例均被排除在MS和“健康对照”队列之外。每个“健康对照”病例被指定为匹配的MS患者的索引日期。MS组和“健康对照”组在索引日期前后均需要连续参保12个月。使用消费者价格指数的适当医疗组成部分将按利用类型细分的成本调整为2010年美元。使用卡方检验、t检验、参数检验和非参数检验比较服务使用情况和成本。
1411例MS病例（65.6%为女性）与7055例“健康对照”病例（65.6%为女性）相匹配。在对索引日期后12个月内的全因医疗保健服务的分析中，MS患者使用所检查的各类医疗服务的可能性显著更高。与“健康对照”组相比，新诊断的MS患者住院的可能性是其3.5倍（MS组为15.2%，对照组为4.3%），至少有1次急诊室（ER）就诊的可能性是其2倍（25.5%对12.2%），至少有1次物理、职业或言语治疗就诊的可能性是其2.4倍（23.7%对9.9%；所有比较的P<0.001）。MS患者与各类服务相关的12个月平均成本也更高（住院服务分别为4110美元对836美元；放射学服务为1693美元对259美元；急诊室为432美元对189美元；门诊就诊为849美元对310美元；治疗为295美元对81美元；所有P值<0.001）。MS患者12个月的全因医疗保健总平均成本显著高于“健康对照”组（分别为18829美元对4038美元，P<0.001）。索赔中任何字段的诊断代码归因于MS或使用MS注射药物所产生的费用平均为8839美元（46.9%），MS注射药物占全因医疗保健总成本的4573美元（24.3%）。
与非MS“健康对照”患者相比，新诊断的MS患者住院、放射学服务以及急诊室和门诊就诊的发生率显著更高。在诊断后的第一年，MS给美国医疗保健系统带来了相当大的负担。
