Cleveland Clinic, Lou Ruvo Center for Brain Health, Las Vegas, NV, USA.
President, Better Health Worldwide, Inc., Newfoundland, NJ, USA.
J Med Econ. 2021 Jan-Dec;24(1):479-486. doi: 10.1080/13696998.2021.1906013.
Multiple sclerosis (MS) poses a substantial employer burden in medically related absenteeism and disability costs due to the chronic and debilitating nature of the disease. Although previous studies have evaluated relapse, nonadherence, discontinuation, and switching individually, little is known about their overall collective prevalence and implications in employees with MS treated with disease-modifying therapies (DMTs). This study evaluated the proportion of employees with MS with suboptimal DMT year-1 outcomes and to quantify the clinical and economic burden of suboptimal year-1 outcomes from a US employer perspective.
Employees with MS were selected from the Workpartners database. Eligibility criteria were: ≥2 MS diagnosis claims (ICD-9-CM 340.xx/ICD-10-CM G35) from January 1, 2010-March 31, 2019, ≥1 once-/twice-daily oral or self-injectable DMT claim (first claim = index), continuous eligibility 6-months pre-/1-year post-index, no baseline DMT, and age 18-64 years. Suboptimal year-1 outcomes included: non-adherence (proportion of days covered <80%), discontinuation (gap >60 days), switch, or relapse (MS-related hospitalization, emergency room visit, or outpatient visit with corticosteroid). A two-part logistic-generalized linear model evaluated costs.
Of 488 eligible patients, half ( = 247; 50.6%) had suboptimal year-1 outcomes (39.5% non-adherence, 9.8% discontinuation, 10.9% switching, 20.7% relapse; not mutually exclusive). Employees with suboptimal year-1 outcomes had higher all-cause medical ($12,730 vs. $6,428; < 0.0001), MS-related medical ($5,444 vs. $2,652; < 0.0001), non-DMT pharmacy ($2,920 vs. $2,169; = 0.0199), sick leave ($1247 vs. $908; = 0.0274), and short-term disability ($934 vs. $146; = 0.0001) costs. Long-term disability ($751 vs. $0; = 0.1250) and Workers' Compensation ($56 vs. $24; = 0.1276) did not significantly differ.
Administrative claims lack clinical information. Results may not be generalizable to other patients or care settings.
Half of the employees with MS in this sample had suboptimal year-1 outcomes (i.e. non-adherence, discontinuation, switching, or relapse). These suboptimal year-1 outcomes were associated with greater medical, sick leave, and short-term disability costs.
多发性硬化症（MS）由于疾病的慢性和衰弱性质，在与医学相关的缺勤和残疾成本方面给雇主带来了巨大负担。尽管先前的研究已经单独评估了复发、不依从、停药和换药，但对于接受疾病修正治疗（DMT）的 MS 患者，它们的总体总体发生率及其对员工的影响知之甚少。本研究评估了在接受 DMT 治疗的 MS 员工中，DMT 治疗第一年结局不理想的比例，并从美国雇主的角度量化了 DMT 治疗第一年结局不理想的临床和经济负担。
从 Workpartners 数据库中选择 MS 患者。入选标准为：2010 年 1 月 1 日至 2019 年 3 月 31 日，≥2 次 MS 诊断（ICD-9-CM 340.xx/ICD-10-CM G35），≥1 次口服或自我注射 DMT 每月/每日两次，索引前 6 个月/索引后 1 年连续资格，无基线 DMT，年龄 18-64 岁。第一年结局不理想包括：不依从（覆盖天数比例<80%）、停药（>60 天）、换药或复发（与 MS 相关的住院治疗、急诊就诊或门诊就诊时使用皮质类固醇）。采用两部分逻辑广义线性模型评估成本。
在 488 名符合条件的患者中，一半（=247；50.6%）第一年结局不理想（39.5%不依从、9.8%停药、10.9%换药、20.7%复发；不互斥）。第一年结局不理想的员工的全因医疗费用（12730 美元对 6428 美元；<0.0001）、MS 相关医疗费用（5444 美元对 2652 美元；<0.0001）、非 DMT 药房费用（2920 美元对 2169 美元；=0.0199）、病假（1247 美元对 908 美元；=0.0274）和短期残疾（934 美元对 146 美元；=0.0001）更高。长期残疾（751 美元对 0 美元；=0.1250）和工人赔偿（56 美元对 24 美元；=0.1276）没有显著差异。
行政索赔缺乏临床信息。结果可能不适用于其他患者或护理环境。
在这项样本中，有一半的 MS 患者第一年的结局不理想（即不依从、停药、换药或复发）。这些第一年结局不理想与更高的医疗、病假和短期残疾费用有关。
