title: Clinical and economic impact of a specialty care management program among patients with multiple sclerosis: a cohort study.
abstract: BACKGROUND
  To evaluate the clinical and economic impact of a specialty care management program among patients with multiple sclerosis.
  
  
  METHODS
  This retrospective cohort analysis included patients aged > or =18 years with > or =2 claims of multiple sclerosis diagnosis and > or =1 multiple sclerosis medications from 1 January 2004 to 30 April 2008. The outcome metrics included medication adherence and persistence, multiple sclerosis-related hospitalization, and multiple sclerosis-related cost. Multivariate analyses were performed to adjust for demographics and clinical characteristics.
  
  
  RESULTS
  Among the 3993 patients identified, 78.3% participated in the program and 21.7% did not. Over 12 months, medication adherence and persistence improved among participants but deteriorated among non-participants (medication possession ratio change: +0.08 vs -0.03, p < 0.001; persistence change: +29.2 days vs -9.2 days, p < 0.001). Multiple sclerosis-related hospitalization decreased from 9.6% to 7.1% for participants, whereas it increased from 10.1% to 12.0% for the non-participant group (p < 0.001). Multiple sclerosis-related medical spending (non-pharmacy) decreased among participants, but it increased among non-participants (mean: -US$264 vs + US$1536, p < 0.001). Total multiple sclerosis-related cost for both groups increased over time (+US$4471 vs +US$4087, p < 0.001).
  
  
  CONCLUSIONS
  This program was associated with improved medication adherence and persistence, reduced multiple sclerosis-related hospitalization, and decreased multiple sclerosis-related medical costs. Unfortunately, the cost savings in the medical component did not offset the increased pharmacy expenditures during the 12-month follow-up period.
authors.affiliation: HealthCore Inc., Wilmington, DE 19801, USA. jtan@healthcore.com
authors.forename: H
authors.initials: H
authors.lastname: Tan
authors.forename: J
authors.initials: J
authors.lastname: Yu
authors.forename: D
authors.initials: D
authors.lastname: Tabby
authors.forename: A
authors.initials: A
authors.lastname: Devries
authors.forename: J
authors.initials: J
authors.lastname: Singer
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000191:economics*; D010593:Pharmaceutical Services / Q000191:economics; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D016903:Drug Monitoring