#ECTRIMS2019 – Relapses Tied to Greater Medical and Personal Costs in Real-world Data
Relapses in people with multiple sclerosis (MS) are associated with greater medical and non-medical costs, according to real-world data from two German observational studies.
These findings support early treatment with disease-modifying therapies (DMTs) that help to control disease relapses, its researchers said, as a way of possibly reducing such economic burden.
Nils-Henning Ness with the University Hospital Dresden presented the data in the talk,“Real-World Evidence on the influence of relapses and relapse associated progression on societal economic costs in patients with multiple sclerosis,” at the 35thcongress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) recently held in Stockholm (Sept. 11–13).
Disability progression and relapses in MS patients are linked to high economic costs, both in medical and other health services, and in activities that impact a patient’s life, like employment.
But the variable nature of MS, as well each patient’s distinct characteristics, can make it difficult to assess such costs.
Researchers aimed to quantify the economic impact of relapses and relapse-associated worsening in MS patients in Germany.
They analyzed two-year data from two observational German trials — PANGAEA and PEARL — that investigated the safety, efficacy, and pharmoeconomics (the cost and value) of disease-modifying therapies given to MS patients: either Gilenya (fingolimod) by Novartis, or BRACE (interferon-beta and Copaxone [glatiramer acetate] by Teva Pharmaceuticals).
In order to quantify the costs associated with relapses and disease progression, researchers used a questionnaire they recently developed — called the MS Health Resource Utilization Survey, a societal-economic tool that differentiates between direct medical and non-medical (other care resources or health sector services that have a supportive character) costs, and indirect costs (including work-related costs).
Their study included 1,546 patients with mild to moderate MS. Participants were assessed at the start of the trials, followed by routine visits every three months to evaluate evidence of relapses. Six-month disability progression (using EDSS scores) was also assessed. The costs of DMTs were not accounted for in the study.
Of these patients, 58% (985 people) had ‘no evidence of disease activity’ (or NEDA) during the two-year follow-up, while 24% (407 people) had at least one relapse event without disease worsening. Nine percent (150 people) had disease worsening with relapse activity, and 10% (166 people) had disease progression independent of relapses.
“The mean EDSS score is quite similar between the four groups,” Ness said, noting values between 2.15 and 2.48.
Quarterly costs in NEDA patients were around 1,703 euros (about $1,877), but increased by 1.4 times in people whose disease progressed independently of relapses (2,392 euros, about $2,636), and by 1.65 times in those with both relapses and disease progression (2,812 euros, approximately $3,099).
Non-medical costs were 2.53 times higher in people with relapses and disease progression than in those with NEDA, and their direct medical costs were 2.25 times higher than NEDA patients. The greater costs for MS patients with relapses and disease progression were “mostly due to a higher rate of hospitalization … and longer stay within the hospital,” Ness said.
The impact of relapses and relapse-associated worsening was striking in terms of work-related indirect costs for this group compared to patients without disease activity. These costs were “mostly due to a higher rate of sick leaves … and productivity restrictions at the workplace,” Ness said.
Based on these results, Ness concluded that “disability worsening significantly increases societal-economic costs.”
It is “highly important to delay or prevent transition into the progressive phase of MS” by administering DMTs early in the management of MS patients, he added.
Ness also emphasized that combining these societal economic results with “epidemiological knowledge could help [in] assessing financial risks to healthcare systems.”