Brüggemann Finn, Gross Stefan, Süße Marie, Hok Pavel, Strauss Sebastian, Ziemssen Tjalf, Frahm Niklas, Zettl Uwe K, Grothe Matthias
Department of Neurology, University Medicine Greifswald, Greifswald, Germany.
Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.
Front Neurol. 2023 Dec 21;14:1330066. doi: 10.3389/fneur.2023.1330066. eCollection 2023.
The aim of this study was to examine the societal costs of polypharmacy in patients with multiple sclerosis (MS). We therefore focused on the association between the number of medications on the level of care (LOC), the German classification of the need for care, and the number of therapy sessions (TTU).
In addition to demographic information and medication, 101 MS patients performed the Multiple Sclerosis Health Resource Utilization Survey (MS-HRS). Medications were subdivided into a total number of medications (TD), MS-related medication [MSD, i.e., disease-modifying drugs (DMDs) and symptomatic treatment (SD)], and medication for comorbidities (CDs). Multivariate linear regression models were performed to estimate if the amount of each medication type affects LOC or TTU.
Polypharmacy appeared in 54 patients at the time of the survey. The relative risk (RR) of LOC 1 increased significantly by 2.46 ( = 0.001) per TD and by 2.55 ( = 0.004) per MSD, but not per CD (RR 1.44; = 0.092). The effect of RR on MSD was driven by SD (RR 2.2; = 0.013) but not DMD (RR 2.6; = 0.4). RR of MSD remained significant for LOC 2 (1.77; = 0.009) and LOC 3/4 (1.91; = 0.015), with a strong trend in RR of SD, but not DMD. TTU increased significantly per MSD ( = 0.012), but not per TD ( = 0.081) and CD ( = 0.724).
The number of MSDs is related to the likelihood of a higher level of care and the number of therapy sessions and is therefore a good indication of the extent of the societal costs.
本研究旨在探讨多发性硬化症（MS）患者多重用药的社会成本。因此，我们重点关注用药数量与护理级别（LOC）、德国护理需求分类以及治疗疗程数量（TTU）之间的关联。
除人口统计学信息和用药情况外，101名MS患者完成了多发性硬化症健康资源利用调查（MS - HRS）。药物被细分为用药总数（TD）、与MS相关的药物[MSD，即疾病修正药物（DMDs）和对症治疗药物（SD）]以及合并症用药（CDs）。采用多元线性回归模型来估计每种药物类型的数量是否会影响LOC或TTU。
调查时54名患者存在多重用药情况。每增加一个TD，LOC 1的相对风险（RR）显著增加2.46（P = 0.001），每增加一个MSD，RR增加2.55（P = 0.004），但每增加一个CD则无显著变化（RR 1.44；P = 0.092）。MSD对RR的影响主要由SD驱动（RR 2.2；P = 0.013），而非DMD（RR 2.6；P = 0.4）。MSD的RR在LOC 2（1.77；P = 0.009）和LOC 3/4（1.91；P = 0.015）时仍具有显著性，SD的RR有强烈趋势，而DMD则无。每增加一个MSD，TTU显著增加（P = 0.012），但每增加一个TD（P = 0.081）和CD（P = 0.724）则无显著变化。
MSD的数量与更高护理级别可能性及治疗疗程数量相关，因此是社会成本程度的一个良好指标。
