Amy L. Phillips

Impact of medication adherence to disease-modifying drugs on severe relapse, and direct and indirect costs among employees with multiple sclerosis in the US.

Abstract Objective: To compare rates of severe relapse and total direct and indirect costs over a 2-year period between US-based employees with multiple sclerosis (MS) who were adherent and non-adherent to disease-modifying drugs (DMDs). Methods: Employees with ≥1 MS diagnosis (ICD-9-CM: 340.x) and ≥1 DMD pharmacy claim between 1/1/2002–12/31/2007 were identified from a large US administrative claims database. Patients had continuous coverage ≥6 months before (baseline) and ≥24 months after (study period) their index date (first DMD claim). Adherence was measured using medication possession ratio (MPR) over the study period. Patients with MPR ≥80% were considered adherent (n = 448) and those with MPR <80% as non-adherent (n = 200). Multivariate analyses were used to compare rates of severe relapse (inpatient or Emergency Department visit with MS diagnosis) and costs in 2007 dollars between DMD adherent and non-adherent patients. Direct costs were calculated as reimbursements to providers for medical services and prescription drugs excluding DMDs. Indirect costs included disability and medically-related absenteeism costs. Results: DMD adherent patients were on average older (43.5 vs 41.8 years, p = 0.015) and more likely to be male (38.6% vs 26.0%, p = 0.002) compared with non-adherent patients. Adherent patients had lower rates of depression, higher rates of previous DMD use, and higher baseline MS-related costs. After adjusting for differences in baseline characteristics, DMD adherent patients had a lower rate of severe relapse (12.4% vs 19.9%, p = 0.013) and lower total (direct and indirect) costs (

The Cost of Disability and Medically Related Absenteeism Among Employees with Multiple Sclerosis in the US

14,095 vs

Medication possession ratio: implications of using fixed and variable observation periods in assessing adherence with disease-modifying drugs in patients with multiple sclerosis

16,638, p = 0.048) over the 2-year study period. Conclusions: In this study, DMD adherence was associated with a significantly lower rate of severe relapse and lower total costs over 2 years. Causality cannot be inferred because adherence and outcomes were measured over the same period. The study was subject to limitations associated with use of claims data and the absence of clinical measures.

Economic impact of multiple sclerosis disease-modifying drugs in an employed population : direct and indirect costs

AbstractBackground: Studies have not previously reported the indirect cost burden of multiple sclerosis (MS) from an employer perspective. Objective: To compare annual indirect costs between privately insured US employees with MS and matched employee controls. Methods: A retrospective analysis of a privately insured claims database containing disability data from 17 US companies was conducted. Employees with ≥1 MS diagnosis (ICD-9-CM: 340.x) after 1 January 2002, aged 18–64 years, were selected. Employees with MS were matched by age and sex to employee controls without MS. All were required to have continuous health coverage 3 months before MS diagnosis (baseline) and 12 months after (study period).Main outcomes measures included study period annual indirect (disability and medically related absenteeism) costs. For completeness, we also included measures of direct (medical and drug) costs. Chi-squared tests were used to compare baseline co-morbidities and differences in indirect resource use (disability and medically related absenteeism) between employees with MS and controls. Wilcoxon rank-sum tests were used for univariate comparisons of disability and medically related absenteeism days and associated annual indirect and direct costs between employees with MS and controls. Generalized linear models, controlling for differences in baseline characteristics, were used to estimate risk-adjusted annual costs for employees with MS and controls. Results: Employees with MS (n = 989) averaged 44 years of age, and 66% were female. Compared with employee controls, employees with MS had significantly higher rates of mental health disorders, other neurological disorders and physical disorders measured by the Charlson Co-morbidity Index. Employees with MS were more likely to have short-term or long-term disability than employee controls (21.4% vs 5.2%, respectively; p < 0.0001), resulting in a higher mean number of disability days per year (29.8 vs 4.5; p < 0.0001). Employees with MS also had a higher rate of medically related absenteeism and associated absenteeism days than employee controls. On average, annual costs (year 2006 values) for disability were significantly higher for employees with MS (

Prevalence and cost of HIV-associated weight loss in a managed care population

US3868) than employee controls (

Self-reported severity among patients with multiple sclerosis in the U.S. and its association with health outcomes.

US414; p < 0.0001). Annual medically related absenteeism costs were also higher for employees with MS than for controls (

The association of timing of disease-modifying drug initiation and relapse in patients with multiple sclerosis using electronic health records

US1901 vs

The effect of age and sex on cost of inpatient facility encounters among patients with multiple sclerosis

US1003, respectively; p < 0.0001). On average, total annual indirect costs for employees with MS were

Pregnancy rates and outcomes in women with and without MS in the United States

US5769 compared with

Factors associated with early initiation of disease-modifying drug treatment in newly-diagnosed patients with multiple sclerosis

US1417 for controls (p < 0.0001). Conclusions: MS is a chronic and debilitating disease that poses a substantial employer burden in terms ofmedically related absenteeism and disability costs. Indirect costs of employees withMS were >4 times those of employee controls.