Comparing costs and absences for multiple sclerosis among US employees: pre- and post-treatment initiation.
BACKGROUND
Limited data exist on the effects of Disease Modifying Treatments (DMTs) on direct and indirect costs among employees treated for Multiple Sclerosis (MS). The objective was to compare costs and absences among employees treated with DMTs (e.g., interferons [IFNs]: IFN-β1a-IM = Avonex = 'A', IFN-β1b = Betaseron = 'B', IFN-β1a-SC = Rebif = 'R', or glatiramer acetate = Copaxone = 'C') for MS pre and post therapy initiation.


METHODS
A healthcare claims database of US employees (2001-2008) was used to identify patients with two or more DMT prescriptions or one DMT prescription with a MS diagnosis (ICD-9 = 340.X) who were continuously employed and with health plan coverage 6 months pre and post DMT initialization. Outcome measures included: direct costs; indirect costs and absences associated with sick leave (SL) and short-term disability (STD); and medical costs and utilization by place of service (POS). All costs are inflation-adjusted to 2010 US$. Between- and within-group outcomes were compared using Student's t-tests for continuous and chi-square tests for discrete variables and considered significant when P ≤ 0.05.


RESULTS
Overall, 153 eligible employees were identified: 'A' = 68, 'B' = 22, 'R' = 21, 'C' = 42; 76 employees had SL eligibility; 89 had STD eligibility; and 97 employees had POS indicators. Following treatment initiation, healthcare costs decreased significantly for 'A' users (-53.8%, -$3084) and 'B' users (-67.1%, -$4103), while SL costs only decreased significantly for 'A' users (-60.5%, -$704); changes in SL absence days for 'A' and 'B' users were significantly lower than for 'C' users (both P < 0.05). In the POS sample, total medical costs significantly decreased for 'A' (-$3643), 'B' (-$3470), and 'C' (-$3762), while 'R' increased ($2093) non-significantly. Only 'A' users had significant proportion-of-care reductions (Emergency Department, Outpatient Hospital, and 'Other' locations).


CONCLUSIONS
Among MS employees treated with DMTs in the real-world, 'A' and 'B' users had significantly greater reductions in SL costs post therapy initiation compared with 'C' and 'R'. Only 'A' users showed a significant reduction in SL absence days, while the other cohorts reported increases.


CONCLUSIONS
Small sample sizes may limit the interpretability of these results.
Biogen Idec, Cambridge, MA, USA.
Krithika
K
Rajagopalan
Richard A
RA
Brook
Ian A
IA
Beren
Nathan L
NL
Kleinman
D000041:Absenteeism; D000328:Adult; D004334:Drug Administration Schedule; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D000068717:Glatiramer Acetate; D017048:Health Care Costs; D006801:Humans; D000068556:Interferon beta-1a; D000068576:Interferon beta-1b; D016899:Interferon-beta / Q000191:economics / Q000627:therapeutic use; D008297:Male; D009103:Multiple Sclerosis / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy*; D010455:Peptides / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D018582:Sick Leave / Q000191:economics; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
D010455:Peptides; D000068576:Interferon beta-1b; D000068717:Glatiramer Acetate; D016899:Interferon-beta; D000068556:Interferon beta-1a