MEDICAL RESOURCE UTILIZATION AND EXPENDITURES BY DISEASE-MODIFYING THERAPY ADHERENCE AND NON-ADHERENCE IN TEXAS MEDICAID PATIENTS WITH MULTIPLE SCLEROSIS

Richards KM,1 Ko JJ,2 Yu T-C,2 Nazareth T,2 Lawson KA1

1The University of Texas College of Pharmacy, Austin, TX, USA; 2Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA

BACKGROUND

METHODS

• Disease-modifying therapies (DMTs) are e�ective in reducing relapses and slowing disability progression in relapsing forms of multiple sclerosis (MS).

• DMT adherence is associated with reduced hospitalizations and medical costs.1-3

• Research indicates that adherence varies by DMT type in commercially insured patients.4,5

• This study investigated DMT adherence and medical resource utilization (inpatient, emergency department, and outpatient visits) and expenditures in the Texas Medicaid population.

Characteristics of Texas Medicaid MS Patients (Table 1)

• The analysis identi�ed 617 Texas Medicaid patients who met the inclusion criteria.

• Patients were 42.7 years old at index on average, 79.3% were female, and 76.5% lived in urban areas.

• 46.0% were white, 24.3% were Hispanic, and 23.8% were African American.

• 54.9% were adherent to DMTs (PDC > 0.8), while 45.1% were non-adherent.

• Patient characteristics were not statistically di�erent (p>0.05) between patients who were and were not DMT adherent.

• Data Source: Texas Medicaid• Texas Medicaid provides health care to approximately 4 million

low-income Texans.• Texas Medicaid Medical and Prescription Claims Databases

- January 1, 2010 – December 31, 2014

• Inclusion Criteria- Presence of MS diagnosis (ICD-9: 340) - 18 - 63 years of age at index- Continuously eligible for Texas Medicaid medical and pharmacy

bene�ts - Presence of DMT claims for:

• dimethyl fumarate• �ngolimod• glatiramer acetate• interferon beta-1a (IM, SC)• interferon beta-1b

• De�nitions- Index date: date of �rst DMT claim on or after July 1, 2010- Follow-up period:12–month period following the index date- Adherence: Proportion of Days Covered (PDC) (out of 365 days) • > 80% = adherent- Expenditures adjusted to $US 2013

• Analyses- Resource utilization and expenditures were compared between

adherence groups and among DMT groups using Mann-Whitney U/Kruskal-Wallis tests for continuous variables and chi-square tests for categorical variables.

- Tests were considered signi�cant when p<0.05.

METHODS & RESULTS

Table 1. Texas Medicaid MS Patients Characteristics

Study Strengths and Limitations• This study sample drew from the entire population of Texas Medicaid MS patients.

• Medication samples that patients may have received are not captured in Medicaid claims data.

• Generalizability beyond Texas Medicaid patients may be limited.

• Relationships are associative and not causal.

Conclusions• These results add to the limited available literature on MS in Medicaid patients.

• Medicaid MS patients who are adherent to DMTs have signi�cantly lower MS-related annual medical expenditures and fewer MS-related inpatient days and ED visits compared to non-adherent patients.

• Adherence, MS-related medical resource utilization, and MS-related medical expenditures di�ered by DMT.

• Fingolimod was associated with the highest proportion of adherent patients and the lowest total MS-related medical expenditures.

• To optimize patient health bene�ts and use of resources, health care providers and decision-makers should be aware of adherence rates associated with DMT products, and actively monitor and encourage DMT adherence among MS patients.

References1. Yermakov S et al. Impact of increasing adherence to disease-modifying therapies on healthcare resource utilization and direct medical and indirect

work loss costs for patients with multiple sclerosis. J Med Econ 2015;18(9):711-20.

2. Steinberg S et al. Impact of adherence to interferons in the treatment of multiple sclerosis. Clin Drug Investig 2010;30(2):89-100.

3. Mager D et al. Relationship between adherence for multiple sclerosis medications and health care costs. Poster presentation, 2016 CMSC Annual Meeting. June 2, 2016.

4. Agashivala N et al. Compliance to �ngolimod and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort study. BMC Neurol 2013;13:38.

5. Bergvall N et al. Persistence with and adherence to �ngolimod compared with other disease-modifying therapies for the treatment of multiple sclerosis: a retrospective US claims database analysis. J Med Econ 2014;17(10):696-707.

Acknowledgments• This work was funded by Novartis Pharmaceuticals Corporation.

• Special thanks to Ashok Vegesna, PharmD, for his review.

• Presented at AMCP-Nexus, National Harbor, MD; October 4, 2016.

• T Nazareth was employed by Novartis at the time of study.

Table 2. MS-Related Medical Resource Utilization and Expenditures by DMT Adherence Status

Figure 1. Di�erences in MS-Related Expenditures

Patients considered adherent if PDC (proportion of days covered) > 0.8.P-values estimated from Chi-square tests for categorical variables and Mann-Whitney U tests for continuous variables. Sig = p<0.05.

MS-Related Resource Utilization and Expenditure Comparisons between DMT Adherent and Non-Adherent Patients (Table 2, Figure 1)

• A signi�cantly lower proportion of adherent patients had at least 1 MS-related ED visit during the 12-month study period (24.8% vs. 32.4%, p=0.037).

• DMT adherent patients had signi�cantly fewer MS-related inpatient days (1.6 v. 2.5, p=0.045) and ED visits (0.4 v. 0.6, p=0.021), while non-adherent patients had fewer MS-related outpatient visits (13.8 vs. 15.7, p=0.002).

• MS-related ED (-$63, p=0.045) and total medical expenditures (DMTs not included; -$457, p=0.018) were signi�cantly lower for DMT adherent patients, while MS-related outpatient expenditures were higher for adherent patients (+$472, p=0.004).

Figure 2. Proportion of Patients Adherent to the Index DMT Figure 3. MS-Related Medical Costs by Index DMT

P-values estimated from Chi-square tests for categorical variables and Kruskal Wallis tests for continuous variables. Sig = p<0.05.

Table 3. MS-Related Healthcare Resource Utilization and Expenditures for Adherent Patients by Index DMTAdherent Patients by Index DMT (Figures 2 & 3, Table 3)

Adherence• The greatest proportion of patients was

adherent (PDC > 0.8) to �ngolimod (67.9%), followed by interferon beta 1-a IM (60.8%) and dimethyl fumarate (60.0%).

MS-related Medical Resource Utilization• Among adherent patients, the mean number

of MS-related inpatient days (p=0.043) and outpatient visits (p=0.041) di�ered signi�cantly by index DMT. The number of inpatient days per patient was lowest for the interferon beta 1-a IM group (1.2 days) and highest for the interferon beta 1-a SC group (2.4 days). The number of outpatient visits was lowest for the glatiramer acetate group (12.0) and highest for the dimethyl fumarate group (25.2).

• Mean annual MS-related medical expenditures were lowest for those whose index drug was �ngolimod ($5,467), followed by subcutaneous interferon beta-1a ($5,717), while highest expenditures were associated with dimethyl fumarate ($8,654).

(Note: The study time period did not allow for a greater number of DMTs due to FDA approval timelines and Medicaid prescribing uptake. Listed medications were available to prescribers and none were non-preferred.)

OBJECTIVES

• To compare Texas Medicaid medical resource utilization and expenditures between DMT adherent and non-adherent patients with MS

• To compare medication adherence, medical resource utilization, and expenditures by DMT