Author Of 2 Presentations
P0054 - Cost of a relapse-free patient in relapsing-remitting multiple sclerosis, a reliable result-based health indicator. (ID 461)
Abstract
Background
Nowadays we know the efficacy and safety of disease-modifying therapies (DMTs) in multiple sclerosis (MS) but we lack result-based health indicators to evaluate its cost-effectiveness.
Objectives
The objective of the study is to analyze if the cost per year of a relapse-free patient is a reliable health indicator comparing the cost between 2016 and 2019 of DMTs in a cohort of relapsing-remitting MS (RRMS) treated with DMTs in a representative population cohort.
Methods
Patients followed in our MS unit during 2019, diagnosed with MS and belonging to our sanitary district were evaluated, our center has the only MS unit in the district. From them, patients diagnosed with RRMS were retrospectively selected for this study. Clinical data were collected prospectively on a 6-monthly basis and at the time of any relapse. All patients were visited by a qualified neurologist who performed a neurological examination assessing the disease severity by the Expanded Disease Status Scale (EDSS). Data from magnetic resonance imaging (MRI) were retrospectively retrieved. The proportion of patients with no evidence of disease activity (NEDA) was analysed. The mean cost of DMTs during 2019 had been analyzed as well as the cost of a relapse-free patient. The cost of a relapse-free patient was a ratio between the total cost of DMTs and the number of relapse-free patients. The results of 2019 were compared with the results already obtained in 2016.
Results
A total of 214 patients belonging to our sanitary district diagnosed with MS and followed in our MS unit in 2019, were selected. They indicated an MS prevalence of 105 per 100000 inhabitants, representative of the expected prevalence of MS in epidemiological population-based studies performed in our area. From them, 183 patients were RRMS and were included in our study. They were 67.8% women, their mean age was 48.3 (SD 12.9) years, their mean age at onset was 31.8 (SD 10.8) years, their disease duration was 16.32 (SD 11.7) years and their median irreversible EDSS was 2.0 (range 0-7.5). From those 183, 126 patients (68.9% of the cohort) were treated with DMTs during 2019, 151 patients (82.5% of the cohort) remained free of relapses during 2019, 171 patients did not increase their EDSS (93.4% of the cohort) and 126 of the 144 with Magnetic Resonance Imaging (MRI) in 2019 had neither new T2 lesions nor gadolinium-enhancing lesions (87.5%). The proportion of NEDA (no evidence of disease activity) in those 144 patients was 69.4%. The mean cost of DMTs per patient in 2019 was 6985.4 euros (95% CI: 5986.9-7983.9) when all patients were considered, relapse-free and relapsing patients as well as treated and not treated, in 2016 it was 7414.3 euros (95% CI: 6325.2-8503.4). The cost per year of DMTs of a relapse-free patient was 8465.8 euros in 2019 and 9762.2 euros in 2016.
Conclusions
The cost per year of a relapse-free patient may be a reliable result-based health indicator given its stability in successive measurements in the same population.
P1024 - Economic impact of the Secondary Progressive Multiple Sclerosis in Spain: Interim analysis of the DISCOVER study (ID 1595)
- C. Oreja-Guevara
- J. Río
- J. Ara Callizo
- M. Hernández Pérez
- J. Gracia Gil
- L. Ramió I Torrentà
- B. Pilo De La Fuente
- A. Alonso Torres
- S. Martínez-Yélamos
- F. Gascón Giménez
- S. Eichau Madueño
- B. Casanova-Estruch
- M. Martínez Ginés
- M. Aguado Valcárcel
- J. Martínez Rodríguez
- A. López Real
- C. López De Silanes
- V. González Quintanilla
- Y. El Berdei Montero
- A. Labiano
- M. Garcés Redondo
- L. Costa-Frossard
- J. García Merino
- F. Castellanos Pinedo
- C. Muñoz Fernández
- V. Meca-Lallana
- T. Castillo-Trivino
- A. Ródríguez-Antiguedad
- J. Peña Martínez
- J. Prieto González
- D. Solar Sánchez
- I. Pérez Molina
- E. Agüera Morales
- N. Herrera Varo
- J. Meca-Lallana
Abstract
Background
Multiple Sclerosis (MS) is a chronic, inflammatory, autoimmune, neurodegenerative disease. Around 19% of treated patients with relapsing-remitting MS progress to Secondary Progressive MS (SPMS) 15 years after disease onset, representing the most severe stage of the disease. MS symptoms lead to a general disability, impacting the quality of life of patients and also being related with an important economic burden on the National Health System, the patients, their caregivers and the whole society.
Objectives
There are limited published data on the economic impact of SPMS. The main objective of the study was to estimate the economic impact of SPMS in Spain.
Methods
DISCOVER (CBAF312AES01) is an observational, non-interventional, cross-sectional, retrospective and multicenter study, including 297 SPMS patients ≥18 years treated and monitored according to routine clinical practice in Spain in 34 public hospitals. All data was collected in one single visit. Primary endpoint: total annual cost per patient, including direct healthcare and non-healthcare costs and indirect costs. Interim results from 99 patients are presented.
Results
62.6% females; mean (SD) age 53.1 (9.3) years; 40.4% with higher education; 86.9% living with a relative. Mean (SD) time since first MS diagnosis was 17.5 (8.9) years and since progression to SPMS 5.2 (4.3) years. At diagnosis, mean (SD) EDSS was 2.0 (1.1), being 5.0 (1.1) at the time of progression and 5.9 (0.8) at the study visit, 47.5% patients reaching EDSS>6. 12.8% of patients presented relapses between 12-24 months before the study. According to EQ-5D-5L, mean (SD) utility (<1) was 0.48 (0.27) for patients with Gd+ lesions and/or relapses 2 years before. According to EQ-5D-5L, mean (SD) utility (<1) for patients with cognitive impairment was 0.45 (0.29) vs 0.51 (0.21) for those without it. Mean (SD) utility for Spanish general population was 0.897 (0.21). EDSS score showed a significative effect (P=0.0074) on the economic burden of the disease, with total costs increasing from 14,546€ (EDSS 4-4.5) to 21,918€ (EDSS 5-5.5) and 26,832€ (EDSS=6). Costs related to patients with EDSS=6 from the societal, patient and healthcare system were 6,441€, 8,450€ and 11,941€, respectively.
Conclusions
Interim results of the DISCOVER study revealed a significant economic impact of MS progression, highlighting the importance of implementing therapeutic strategies specific to the SPMS patient within the early stages of progression.