Socio-Economic Disparity in Treatment and Healthcare Resource Use in Patients with Multiple Sclerosis Covered By Medicaid

Background: The number of FDA-approved disease modifying therapies (DMT) in multiple sclerosis (MS) has increased over the last decade but there are a large percentage of eligible patients, who may benefit from a DMT who are not on therapy based on a recent Medicaid analysis. Because the diagnosis of MS has been increasing in minority populations, there is a possibility that racial/ethnic disparities may exist in DMT use and health resource utilization. 

Objectives: To characterize DMT utilization, healthcare resource use (HRU), and disability progression across different racial/ethnic groups of MS patients in the Medicaid population.

Methods: A retrospective claims analysis was conducted to identify MS patients (2 or more claims with ICD-9 340 or 1 claim + DMT within 1 year of 1^st claim ), utilizing the Truven Medicaid database who were continuously enrolled from 2010-2014. We assessed HRU, disability progression as defined by time to event (cane/walker/wheelchair), DMT utilization and time to DMT stratified by self-reported race/ethnicity (white vs. non-white). 

Results: In total 6,742 MS patients were identified. Mean age was 50.9 yrs, 62% white and 38% non-white (Black, Hispanic, and Other), and only 23% were on a DMT. Within the treated cohort, there were no significant differences in % on a DMT (21% vs. 26%) or time to DMT (7.8 vs 6.8 months) between white vs. non-white MS patients, respectively. However, in the non-white, non-DMT cohort, there was a significantly greater use in total HRU (p=0.03) compared to the white, non-DMT cohort.

Of those patients treated with a DMT, regardless of race/ethnicity, a significant reduction in total HRU was observed (p<0.0001) as well as a significant reduction in disability progression defined by time to cane/walker (p<0.05, unadjusted) or wheelchair (p<0.0004, unadjusted). Sensitivity analysis will be performed to adjust for confounders (age, disease duration, etc).

Conclusions: These findings suggest that race/ethnicity does not affect DMT use by MS patients within the Medicaid population, although we did identify a racial/ethnic disparity in HRU among patients not on a DMT. An increased use of healthcare resources and greater disability progression in untreated patients was also detected which merits further exploration. Further studies are needed to better define other socioeconomic barriers that may exist in outcomes and utilization of services in this population.