#ACTRIMS2021 – Taking Medication During Pregnancy Reduces Healthcare Costs
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Women with multiple sclerosis (MS) who continue taking disease-modifying therapies (DMTs) throughout pregnancy accrue lower non-maternity healthcare costs related to hospitalization, new research shows.
Overall, the adjusted medical costs for patients who were consistently taking all of their medications were lowered by as much as $4,383, an analysis found.
The findings were presented at the virtual Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2021, in a poster titled “Multiple sclerosis disease modifying therapies’ adherence and total medical costs among women with maternity services using administrative data.” It was authored by investigators from Walgreen and AllianceRx Walgreens Prime; Walgreen internally funded the research.
According to the National MS Society, no DMTs are currently approved for use during pregnancy — however, stopping treatment can increase the risk of relapses and associated health problems for people with MS.
“When it comes to pregnancy or thinking of becoming pregnant, a key discussion on the risks and benefits of DMT therapy must take place between the patient and provider,” Kathleen Love, a clinical program manager at AllianceRx Walgreens Prime and poster co-author, said in a press release.
“MS is so unpredictable and unique per individual. There are so many choices now for patients with MS, and a very key component in therapy along the continuum of their life is their discussion about their DMT with their prescriber,” added Love, a registered nurse.
The new findings build on previous work showing that higher adherence — that is, taking medications as often as directed — can reduce hospitalizations and associated costs among people with MS.
“In the broader study [with MS patients and not just pregnant MS patients], we did see a relationship between patients who are more adherent having a lower total healthcare cost,” said Heather Kirkham, PhD, poster co-author and director of health analytics, research and reporting at Walgreens.
Kirkham noted that the new analyses now focused on pregnant women “because they might have a different experience” than the broader patient population.
Using insurance data, the researchers identified 604 women with MS who became pregnant between 2015 and 2017. The researchers assessed their use of DMTs and of other healthcare resources over the course of two years.
At index, or the start of the assessed period, the most commonly used DMTs were glatiramer acetate (marketed as Copaxone, Glatopa, and other generics) by 46.4% of the patients, and Tecfidera (dimethyl fumarate) by 12.1%.
Overall, 82.7% of the analyzed pregnancies occurred in the first year of follow-up. Among 500 patients with first-year pregnancies, 395 (79%) discontinued DMT use into their second year.
Rates of adherence during pregnancy varied based on medication, from as high as 11.2% for glatiramer acetate and as low as 0% for interferon beta 1b therapies (such as Betaseron, among others). Over the analyzed period, 53 patients switched from one DMT to another.
“MS patients in maternity typically reduce their DMT medication adherence, but a significant number continue, and even demonstrate good adherence levels,” the researchers wrote.
Among the analyzed patients, a total of 48 had comorbidities, or healthcare problems other than MS, such as diabetes. One individual, who had very high healthcare-related costs due to a concurrent cancer diagnosis, was excluded from additional cost analyses.
Of the remaining 603 patients analyzed, 9.2% were adherent in both years analyzed, while 36.9% were adherent in one year but non-adherent in the other. A majority (53.9%) were non-adherent in both years.
Mean DMT-associated costs were significantly higher among those who were adherent in both years ($142,372) compared with those who were non-adherent in one ($97,671) or both years ($54,014). Higher DMT cost also was associated with changing DMT, using mail order, and taking more of other types of therapies.
Adjusted medical costs were significantly lower in patients who were adherent in both years ($2,314) compared to those who were non-adherent in one ($5,265) or both years ($6,697). “Adjusted medical costs” refers to costs accrued from inpatient and outpatient hospital visits, less the cost of care related to maternity.
Adjusted medical costs also were significantly higher in individuals who changed DMTs, those who were taking more types of other medications, and women who had more comorbidities.
Overall, “mean non-maternity medical costs for adherent patients was significantly lower compared to other two DMT non-adherent or discontinued patient groups,” the team concluded.