The growing reliance on disease-modifying therapies (DMTs) to treat people with multiple sclerosis (MS) has led to fewer hospitalizations but not a drop in the number of physician visits, a population study of DMTs and their impact on healthcare use in Canada reports.
The study, “Association between disease-modifying therapies for multiple sclerosis and healthcare utilisation on a population level: a retrospective cohort study,” was published in the journal BMJ Neurology Open.
In the last two decades, many disease-modifying treatments — those that reduce the activity and progression of a disease — have become available for MS. How their use affects healthcare utilization by patients, however, is less known.
DMTs tend to be expensive, and some believe that their use imposes a considerable economic burden on both patients and insurance companies or governments. Others argue that DMTs are cost-effective in the long term, because those taking them end up with fewer hospital admissions and relapses requiring treatment.
“Understanding the impact that DMTs have on healthcare utilization at a population level will help guide health policy decisions related to issues such as the reimbursement or coverage of therapies,” the researchers wrote.
The team, led by researchers at the University of Saskatchewan, assessed the association between DMTs and healthcare utilization among all adults enrolled in the drug plan for the Canadian province of Saskatchewan, and among all adult MS patients enrolled in the plan for that province, between January 1996 and December 2016. The information was extracted from the administrative databases of the Saskatchewan government.
Saskatchewan, like other Canadian provinces, has one of the highest rates of MS worldwide, with a prevalence estimated at 313.6 per every 100,000 people in 2013, the study reported. The population of Saskatchewan was almost 1.1 million in 2016.
Researchers focused on the association between the times that MS patients took DMTs each year, and the number and length of their hospitalizations, as well as physician visits. The study did not differentiate between the types of MS and disease severity.
Between Jan. 1, 1997, and Dec. 31, 2016, prescriptions for DMTs rose from 27 to 9,246, and the number of patients receiving at least one DMT dispensation each year from 23 to 945.
MS patients who had more DMT dispensations tended to have fewer all-cause and MS-specific hospitalizations, results showed. The researchers also noted an increase in the length of all-cause hospital stays among patients receiving more DMTs, with a mean hospital stay of 8.4 days, but this finding was not statistically significant.
“So although hospitalisation rates have decreased over time, it appears that those individuals who are hospitalised are sicker, and require more complex care,” the researchers wrote. “It is also possible that some individuals with MS remain in hospital longer as they wait for placement in a long-term care facility, or are receiving inpatient rehabilitation.”
Similar hospitalization trends were also noted for the general population.
The frequency of DMT administration did not influence the number of all-cause and MS-specific physician visits, based on data covering all physician submissions for reimbursement.
“Many of the DMTs require regular monitoring and follow-up; therefore, it is not unrealistic to expect that DMT use would increase the number of physician claims,” the researchers wrote.
“Any increase related to DMT prescribing and monitoring may be offset by a reduction in physician services in other areas, such as relapse management,” they added.
The team concluded that “increased DMT use over two decades in Saskatchewan has been associated with a reduction in all-cause and MS-specific hospitalizations, but has not impacted the number of physician services used.”
They thought this “consistent with the existing literature demonstrating individuals living with MS are approximately twice as likely to be hospitalised, visit a medical professional or consult a mental health professional as compared with the general population.”
The research team suggested that further research “into areas such as cost-benefit and different treatment strategies (eg, escalation vs initial highly active therapy)” was necessary to understand “the true impact of DMTs on healthcare utilization at a population level.”