Munsell Michael, Frean Molly, Menzin Joseph, Phillips Amy L
Boston Health Economics, Inc., 20 Fox Road, Waltham, MA, 02451, USA.
Health Economics & Outcomes Research, EMD Serono, Inc., One Technology Place, Rockland, MA, 02370, USA.
BMC Neurol. 2017 Jun 5;17(1):106. doi: 10.1186/s12883-017-0887-1.
Administrative healthcare claims data provide a mechanism for assessing and monitoring multiple sclerosis (MS) disease status across large, clinically representative "real-world" populations. The estimation of MS disease status using administrative claims can be a challenge, however, due to a lack of detailed clinical information. Retrospective claims analyses in MS have traditionally used rates of MS relapses to approximate disease status. Healthcare costs may be alternate, broader claims-based indicators of disease activity because costs reflect multiple facets of care of patients with MS, and there is a strong correlation between quality of life of patients with MS and costs of the disease. This study developed, tested, and validated a healthcare cost-based measure to serve as an indicator of overall disease status in patients with MS treated with disease-modifying drugs (DMDs) utilizing administrative claims.
Using IMS Health Real World Data Adjudicated Claims - US data (January 2006-June 2013), a negative binomial regression predicted annual all-cause medical costs. Coefficients reaching statistical significance (p < 0.05) and increasing costs by ≥5% were selected for inclusion into an MS-specific severity score (scale of 0 to 100). Components of the score included rehabilitation services, altered mental state, pain, disability, stiffness, balance disorder, urinary incontinence, numbness, malaise/fatigue, and infections. Coefficient weights represented each predictor's contribution. The predictive model was derived using 50% of a random sample and tested/validated using the remaining 50%.
Average overall predicted annual total medical cost was $11,134 (development sample, n = 11,384, vs. $10,528 actual) and $11,303 (validation sample, n = 11,385, vs. $10,620 actual). The model had consistent bias (approximately +$600 or +6% of actual costs) for both samples. In the validation sample, mean MS disease status scores were 0.24, 8.95, and 21.77 for low, medium, and high tertiles, respectively. Mean costs were most accurately predicted among less severe patients ($5243 predicted vs. $5233 actual cost for lowest tertile).
The algorithm developed in this study provides an initial step to helping understand and potentially predict cost changes for a commercially insured MS population.
行政医疗保健索赔数据提供了一种机制，可用于评估和监测大型、具有临床代表性的“真实世界”人群中的多发性硬化症（MS）疾病状态。然而，由于缺乏详细的临床信息，使用行政索赔来估计MS疾病状态可能具有挑战性。MS的回顾性索赔分析传统上使用MS复发率来近似疾病状态。医疗保健成本可能是基于索赔的替代的、更广泛的疾病活动指标，因为成本反映了MS患者护理的多个方面，并且MS患者的生活质量与疾病成本之间存在很强的相关性。本研究开发、测试并验证了一种基于医疗保健成本的测量方法，以作为使用行政索赔接受疾病修饰药物（DMD）治疗的MS患者总体疾病状态的指标。
使用艾美仕市场研究公司的真实世界数据裁决索赔——美国数据（2006年1月至2013年6月），负二项回归预测年度全因医疗成本。选择达到统计学显著性（p < 0.05）且成本增加≥5%的系数纳入特定于MS的严重程度评分（范围为0至100）。评分的组成部分包括康复服务、精神状态改变、疼痛、残疾、僵硬、平衡障碍、尿失禁、麻木、不适/疲劳和感染。系数权重代表每个预测因子的贡献。预测模型使用随机样本的50%推导得出，并使用其余50%进行测试/验证。
平均总体预测年度总医疗成本为11,134美元（开发样本，n = 11,384，实际为10,528美元）和11,303美元（验证样本，n = 11,385，实际为10,620美元）。该模型对两个样本都有一致的偏差（约+600美元或实际成本的+6%）。在验证样本中，低、中、高三分位数的平均MS疾病状态评分分别为0.24、8.95和21.77。在病情较轻的患者中，平均成本的预测最为准确（最低三分位数的预测成本为5243美元，实际成本为5233美元）。
本研究中开发的算法为帮助理解并潜在预测商业保险MS人群的成本变化提供了第一步。
