Clinical Characteristics Associated with High Cost MS Patients Using Claims and Medical Records Data, Stratified By Cost

Background: Multiple Sclerosis (MS) is a chronic debilitating disease that impacts the central nervous system. Little clinical information can be obtained from administrative claims data and medical record review is necessary.  

Objectives: To assess clinical characteristics of patients via medical record review, stratified by low, medium and high cost, as determined from administrative claims. 

Methods: Newly diagnosed MS patients aged ≥18 years in the HealthCore Integrated Research Environment (HIRE^SM) during an intake period of 1/1/2007-4/30/2011 were identified. Annualized MS-related cost was computed and patients were stratified into high, medium and low cost strata. A total of 400 patients with confirmed MS diagnosis and documentation of brain MRI were selected for medical record review. Bivariate analyses and multivariate logistic regression models were used to identify factors associated with high cost patients. Patient demographics and clinical characteristics were explored in the bivariate and multivariate analyses.

Results: 400 patient medical records were abstracted, with 84, 132 and 184 patients in the low, medium and high cost groups, respectively. Patients had a mean age of 41 at MS diagnosis and 70% were female. 97% patients had brain MRI results documented in their medical records. Of 389 patients with MRI results, 32% low, 54% medium, and 35% high had active lesions (P <0.01). Common symptoms reported were numbness (63%), fatigue (59%) and pain (59%). 14% low, 40% medium and 33% high cost patients had relapsing remitting disease (P <0.01). 52% of the patients had gait impairment, ranging from 38% low, 44% medium to 64% high cost group (P <0.01). Additionally, patients with baseline documentation of other brain MRI results not related to T-2 imaging, active lesions, demylenation, black holes, or brain atrophy (OR=2.67, 95% CI=1.53-4.65), and baseline corticosteroid use (OR=3.01, 95% CI=1.66-5.45) were more likely to be high cost MS patients (P<0.01).

Conclusions: Baseline use of corticosteroids and documentation of other brain MRI results were significantly associated with high cost MS patients. This study provides insight into factors associated with high cost MS patients and may help to prospectively identify potential high cost MS patients that may benefit from cost-effective proactive clinical management.