title: Adherence and cost in multiple sclerosis patients treated with IM IFN beta-1a: impact of the CARE patient management program.
abstract: BACKGROUND
  Disease modifying treatments (DMT) for MS such as interferon beta (IFNβ) have been shown to reduce the risk for disease progression. Therefore adherence to treatment is essential for treatment outcome.Here we want to evaluate if participation in a patient management program (PMP) improves adherence to DMT as well as health and cost outcomes associated with MS.
  
  
  METHODS
  In this open-label multicentre prospective observational study, German MS patients treated with once weekly intramuscular (IM) IFNβ-1a (Avonex), were offered participation in a PMP and followed for up to 12 months. The PMP included injection trainings, support and quarterly visits for up to 12 months after initiation of therapy. Utilisation of health care services was evaluated. The primary endpoint was to evaluate the direct and indirect cost associated with MS from payer, patient and societal perspective, in patients who participate in the PMP. Secondary endpoint was the clinical outcome in patients who participate in the PMP (differentiated in adherent versus non-adherent patients).
  
  
  RESULTS
  In total 731 patients (mean age: 38.2, 73.7% female) were enrolled, 640 (88%) were observed for twelve months. After six months 34% of patients had participated in the PMP continuously and 21% temporarily; 39% had not participated. After twelve months, the proportions of participants were: 37% continuously and 19% temporarily; 40% had not participated. After 6 months, mean reduction in cost per patient in the participants group (€ 2151) was almost twice as high as the cost reduction amongst non-participants (€ 1131). After twelve months, the annual relapse rate was reduced by 58% compared to baseline in both the participant and non-participant groups.
  
  
  CONCLUSIONS
  In a real-world-setting, participation in a patient management program was associated with improved medication adherence and lower total MS-related direct and indirect cost over time.
authors.affiliation: Department of Neurology, Evangelic Hospital Unna, Holbeinstr. 10, 59423, Unna, Germany. Zaza.Katsarava@uk-essen.de.|Department of Neurology, University Hospital Essen, Essen, Germany. Zaza.Katsarava@uk-essen.de.
authors.forename: Zaza
authors.initials: Z
authors.lastname: Katsarava
authors.affiliation: IMS HEALTH, Munich, Germany. BEhlken@de.imshealth.com.
authors.forename: Birgit
authors.initials: B
authors.lastname: Ehlken
authors.affiliation: Department of Neurology, Cologne City Hospitals, University of Cologne, Cologne, Germany. LimmrothV@kliniken-koeln.de.
authors.forename: Volker
authors.initials: V
authors.lastname: Limmroth
authors.affiliation: Biogen GmbH, Ismaning, Germany. kirsi.taipale@biogen.com.
authors.forename: Kirsi
authors.initials: K
authors.lastname: Taipale
authors.affiliation: Biogen GmbH, Ismaning, Germany. sarita.noemi.patel@biogen.com.
authors.forename: Sarita Noemi
authors.initials: SN
authors.lastname: Patel
authors.affiliation: Biogen GmbH, Ismaning, Germany. gabriele.niemczyk@biogen.com.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Niemczyk
authors.affiliation: Biogen GmbH, Ismaning, Germany. karin.rehberg-weber@biogen.com.
authors.forename: Karin
authors.initials: K
authors.lastname: Rehberg-Weber
authors.affiliation: Biogen GmbH, Ismaning, Germany. colin.wernsdoerfer@biogen.com.
authors.forename: Colin
authors.initials: C
authors.lastname: Wernsdörfer
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D000068556:Interferon beta-1a / Q000008:administration & dosage*; D008297:Male; D055118:Medication Adherence; D009103:Multiple Sclerosis / Q000188:drug therapy*; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000068556:Interferon beta-1a