Optum Inc., Eden Prairie, MN, USA.
Thomas Jefferson University, Philadelphia, PA, USA.
Curr Med Res Opin. 2021 Apr;37(4):597-604. doi: 10.1080/03007995.2021.1885367. Epub 2021 Feb 26.
The objective of this study was to describe and compare health care resource utilization (HCRU) and disease modifying treatment (DMT) use among US adults <65 years with multiple sclerosis (MS), across commercial and Medicare Advantage plans.
Medical and pharmacy claims data from commercial and Medicare Advantage with Part D (MAPD) plans were extracted for MS patients age 18 - 64 identified between 1 January 2014 and 31 May 2017. Comparisons were made between commercial and MAPD enrollees for all-cause HCRU and DMT use over 1 year, overall and by 5 year age groups.
A total of 28,427 MS patients were identified; two-thirds (67%) had commercial coverage. MAPD patients had statistically significantly higher mean counts of all-cause inpatient, emergency room (ER) and ambulatory visits compared to commercial patients. The significant differences were evident in all age groups ≥30 years, except for ER visits in the 40-44 and 60-64 age groups. MAPD patients had statistically significantly lower prevalence of DMT use compared to commercial patients in all age groups starting at ≥35 years.
MAPD patients had a higher burden of medical HCRU compared to their commercially insured counterparts, most likely due primarily to their more advanced disease state and higher level of MS-related disability. Reasons for lower prevalence of DMT use among MAPD patients may include their more advanced disease state, older age and higher prevalence of comorbid conditions compared with commercially insured patients, as well as more restrictive formularies for MAPD vs. commercial plans. These findings suggest that there may be an opportunity for recently approved DMTs indicated for active secondary progressive MS to fulfill an unmet need for treatment among MS patients <65 years without contraindicated comorbid conditions who are enrolled in MAPD plans. Novel therapies under development to delay progression may help keep MS patients of working age in the work force.
本研究旨在描述和比较美国<65 岁患有多发性硬化症（MS）的成年人在商业和医疗保险优势计划（Medicare Advantage with Part D，MAPD）中，健康护理资源利用（Health Care Resource Utilization，HCRU）和疾病修正治疗（Disease Modifying Treatment，DMT）的使用情况。
从商业和具有 D 部分（Part D）的 MAPD 计划中提取了年龄在 18-64 岁之间的 MS 患者的医疗和药房索赔数据，这些患者在 2014 年 1 月 1 日至 2017 年 5 月 31 日之间被确诊为 MS。比较了商业和 MAPD 参与者在 1 年内的全因 HCRU 和 DMT 使用情况，包括整体和按 5 年年龄组比较。
共确定了 28427 名 MS 患者；三分之二（67%）有商业保险。与商业患者相比，MAPD 患者的全因住院、急诊室（Emergency Room，ER）和门诊就诊的平均次数明显更高。除了 40-44 岁和 60-64 岁年龄组的 ER 就诊外，这种显著差异在所有年龄组≥30 岁的患者中都很明显。从≥35 岁开始，MAPD 患者的 DMT 使用率明显低于商业患者。
与商业保险的患者相比，MAPD 患者的医疗 HCRU 负担更高，这很可能主要是由于他们的疾病状况更为严重，MS 相关残疾程度更高。MAPD 患者 DMT 使用率较低的原因可能包括他们的疾病状况更为严重，年龄较大，与商业保险的患者相比，共病的患病率更高，以及 MAPD 与商业计划相比，配方更为严格。这些发现表明，对于最近批准的用于活跃的继发性进展性 MS 的 DMT，可能有机会满足 MAPD 计划中没有禁忌症的共病的<65 岁 MS 患者的未满足的治疗需求。正在开发的用于延缓进展的新型疗法可能有助于使处于工作年龄的 MS 患者继续留在劳动力中。
