Comparison of Costs and Health Resource Utilization in Multiple Sclerosis Patients Treated with Disease-Modifying Therapies
Objectives: To compare the change in costs and health resource utilization of MS patients who initiated delayed-release dimethyl fumarate (DMF; also known as gastro-resistant DMF), glatiramer acetate (GA), interferon (IFN), fingolimod (FTY), or teriflunomide (TER).
Methods: A large administrative US-based claims database (MarketScan) was used. Adult MS patients (18-64 years) who initiated a DMT of interest in 2013 were included. Patients were not treated with DMT in the year prior to the date of DMT initiation (index date). Total healthcare cost and non-prescription medical cost were compared for one year pre- and post-the index date. Difference-in-differences estimate was used to assess the difference in cost between DMF and other DMTs over time while adjusting for demographics and Charlson Comorbidity Index (CCI).
Results: Among the patients previously untreated with a DMT, total of 1,048 initiated DMF, 891 GA, 765 IFN, 207 FTY, and 170 TER. Baseline differences between these groups were seen in age (45.4, 43.2, 43.7, 44.4, and 48.6, respectively; p<0.0001), CCI (0.65, 0.78, 0.73, 0.48, and 0.69, respectively; p=0.02), and annual healthcare cost before the index date ($21,905, $17,646, $16,823, $23,541, and $20,130, respectively; p<0.01). Total annual healthcare cost increased by $38,561, $45,559, $44,942 $53,626, and $43,137 after the initiation of DMF, GA, IFN, FTY, and TER, respectively (p<0.01). Among these groups, the reduction in annual non-prescription medical cost was $6,747 for DMF, $1,453 for GA, $2,746 for IFN, $4,246 for FTY, and $581 for TER (p<0.01). The difference between DMF and other DMTs remains consistent after controlling for confounders.
Conclusions: DMF had the lowest increase in total healthcare cost and the highest reduction in non-prescription medical cost among the DMTs compared.