title: Health care resource utilization before and after natalizumab initiation among patients with multiple sclerosis in Germany.
abstract: BACKGROUND
  Multiple sclerosis (MS), a progressive neurodegenerative disease, greatly impacts the quality of life and economic status of people affected by this disease. In Germany, the total annual cost of MS is estimated at €40,000 per person with MS. Natalizumab has shown to slow MS disease progression, reduce relapses, and improve the quality of life of people with MS.
  
  
  OBJECTIVE
  To evaluate MS-related and all-cause health care resource utilization and costs among German MS patients during the 12 months before and after initiation of natalizumab in a real-world setting.
  
  
  METHODS
  The current analysis was conducted using the Health Risk Institute research database. Identified patients were aged ≥18 years with ≥1 diagnosis of MS and had initiated natalizumab therapy (index), with 12-month pre- and post-index-period data. Patients were stratified by prior disease-modifying therapy (DMT) usage or no DMT usage in the pre-index period. Outcome measures included corticosteroid use and number of sick/disability days, inpatient stays, and outpatient visits. Health care costs were calculated separately for pre- and post-index periods on a per-patient basis and adjusted for inflation.
  
  
  RESULTS
  In a final sample of 193 natalizumab-treated patients, per-patient MS-related corticosteroid use was reduced by 62.3%, MS-related sick days by 27.6%, and inpatient costs by 78.3% from the pre- to post-index period. Furthermore, the proportion of patients with MS-related hospitalizations decreased from 49.7% to 14.0% (P<0.001); this reduction was seen for patients with and without prior DMT use.
  
  
  CONCLUSIONS
  In a real-world setting in Germany, initiation of natalizumab treatment in people with MS significantly reduced MS-related hospitalizations, corticosteroid use, sick days, and associated costs.
authors.affiliation: Health Economics and Outcomes Research, Global Market Access, Biogen, Cambridge, MA, USA.
authors.forename: Crystal
authors.initials: C
authors.lastname: Watson
authors.affiliation: Real World Evidence, Xcenda GmbH, Hanover, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Prosser
authors.affiliation: Real World Evidence, Xcenda GmbH, Hanover, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Braun
authors.affiliation: Applied Data Analytics, Xcenda LLC, Palm Harbor, FL, USA.
authors.forename: Pamela B
authors.initials: PB
authors.lastname: Landsman-Blumberg
authors.affiliation: Market Access, Biogen, Ismaning, Germany.
authors.forename: Erika
authors.initials: E
authors.lastname: Gleissner
authors.affiliation: Health Economics and Outcomes Research, Global Market Access, Biogen, Cambridge, MA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Naoshy
keywords: costs; health care resource utilization; multiple sclerosis; natalizumab; outcomes; relapsing–remitting