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.
OBJECTIVES
To estimate the effect of adherence to disease-modifying therapies (DMTs) among patients with multiple sclerosis (MS) on healthcare resource utilization (HRU) and costs, and model the impact of a 10 percentage point increase in adherence on these outcomes.


METHODS
Employed patients, 18-64 years old, with ≥2 MS diagnoses and ≥1 DMT claim during January 1, 2002 to September 30, 2012 were identified from a large commercially-insured US claims database. Adherence was measured as proportion of days covered (PDC) during follow-up. Multivariate regression analyses were conducted to estimate the effect of adherence on HRU related to urgent care (i.e., inpatient or emergency room visit), days of work loss, direct medical cost, and indirect work loss costs. Model coefficients were used to evaluate the impact of a 10 percentage point increase in adherence on the outcomes.


RESULTS
A total of 1510 patients were included (mean age = 43.4 years, 64% female). Patients with higher adherence had lower HRU, fewer days of work loss, and lower direct and indirect costs. A 10 percentage point increase in adherence significantly decreased the likelihood of an inpatient or emergency room visit by 9-19%, days of work loss by 3-8%, and direct and indirect costs by 3-5%, depending on the follow-up period (all p < 0.01).


CONCLUSIONS
Increasing DMT adherence was found to significantly decrease urgent-care HRU, days of work loss, and direct and indirect costs among patients with MS.
['Yermakov|Sander|S|', 'Davis|Matthew|M|', 'Calnan|Michaela|M|', 'Fay|Monica|M|', 'Cox-Buckley|Brieana|B|', 'Sarda|Sujata|S|', 'Duh|Mei Sheng|MS|', 'Iyer|Ravi|R|']
D000293:Adolescent D000328:Adult D018501:Antirheumatic Agents D015897:Comorbidity D005260:Female D005102:Health Expenditures D006304:Health Status D006801:Humans D007345:Insurance Claim Review D008297:Male D055118:Medication Adherence D008603:Mental Health D008875:Middle Aged D009103:Multiple Sclerosis D010342:Patient Acceptance of Health Care D012189:Retrospective Studies D012959:Socioeconomic Factors D014481:United States D055815:Young Adult
Disease-modifying therapies Work loss Multiple sclerosis Indirect cost Direct cost Medication adherence