Guo Amy, Grabner Michael, Palli Swetha Rao, Elder Jessica, Sidovar Matthew, Aupperle Peter, Krieger Stephen
Acorda Therapeutics Inc., Ardsley, New York, NY, USA.
HealthCore Inc., Wilmington, DE, USA.
Clinicoecon Outcomes Res. 2016 May 12;8:177-86. doi: 10.2147/CEOR.S99750. eCollection 2016.
Although previous studies have demonstrated the clinical benefits of dalfampridine extended release (D-ER) tablets in patients with multiple sclerosis (MS), there are limited real-world data on D-ER utilization and associated outcomes in patients with MS.
The objective of this study was to evaluate treatment patterns, budget impact, and health care resource utilization (HRU) associated with D-ER use in a real-world setting.
A retrospective claims database analysis was conducted using the HealthCore Integrated Research Database(SM). Adherence (measured by medication possession ratio, or [MPR]) and persistence (measured by days between initial D-ER claim and discontinuation or end of follow-up) were evaluated over 1-year follow-up. Budget impact was calculated as cost per member per month (PMPM) over the available follow-up period. D-ER and control cohorts were propensity-score matched on baseline demographics, comorbidities, and MS-related resource utilization to compare walking-impairment-related HRU over follow-up.
Of the 2,138 MS patients identified, 1,200 were not treated with D-ER (control) and 938 were treated with D-ER. Patients were aged 51 years on average and 74% female. Approximately 82.6% of D-ER patients were adherent (MPR >80%). The estimated budget impact range of D-ER was $0.014-$0.026 PMPM. Propensity-score-matched D-ER and controls yielded 479 patients in each cohort. Postmatching comparison showed that the D-ER cohort was associated with fewer physician (21.5% vs 62.4%, P<0.0001) and other outpatient visits (22.8% vs 51.4%, P<0.0001) over the 12-month follow-up. Changes in HRU from follow-up to baseline were lower in the D-ER cohort for metrics including walking-impairment-related hospitalizations and emergency department visits.
The majority of D-ER patients were adherent to treatment. D-ER utilization was associated with fewer walking-impairment-related physician and outpatient visits, with lower HRU increase over time. The budget impact of D-ER was low.
尽管先前的研究已证明缓释氨吡啶（D-ER）片对多发性硬化症（MS）患者具有临床益处，但关于MS患者使用D-ER的实际数据以及相关结果却很有限。
本研究的目的是评估在实际环境中与使用D-ER相关的治疗模式、预算影响和医疗保健资源利用（HRU）情况。
使用HealthCore综合研究数据库（SM）进行回顾性索赔数据库分析。在1年的随访期内评估依从性（通过药物持有率或[MPR]衡量）和持续性（通过首次D-ER索赔与停药或随访结束之间的天数衡量）。预算影响计算为在可用随访期内的每位成员每月成本（PMPM）。D-ER队列和对照队列在基线人口统计学、合并症和与MS相关的资源利用方面进行倾向得分匹配，以比较随访期间与步行障碍相关的HRU。
在确定的2138例MS患者中，1200例未接受D-ER治疗（对照），938例接受D-ER治疗。患者平均年龄为51岁，女性占74%。约82.6%的D-ER患者依从性良好（MPR>80%）。D-ER的估计预算影响范围为0.014 - 0.026美元/月/人。倾向得分匹配后的D-ER队列和对照队列各有479例患者。匹配后比较显示，在12个月的随访期内，D-ER队列的医生就诊次数（21.5%对62.4%，P<0.0001）和其他门诊就诊次数（22.8%对51.4%，P<0.0001）较少。在包括与步行障碍相关的住院和急诊科就诊等指标方面，D-ER队列从随访到基线的HRU变化较小。
大多数D-ER患者坚持治疗。使用D-ER与较少的与步行障碍相关的医生和门诊就诊次数相关，且随着时间推移HRU增加较低。D-ER的预算影响较低。
