Author Of 2 Presentations
P0133 - Prediction of MS disability status in Japanese claims database using principal component analysis (ID 553)
Abstract
Background
Claims databases are widely used in MS research to evaluate clinical practice and outcome of MS treatments in real-world settings. However, disability status as indicated by Expanded Disability Status Scale (EDSS) is not available in claim databases, which makes it difficult to evaluate current healthcare situation of MS patients with higher disability status like SPMS.
Objectives
To describe healthcare situation in Japanese MS patients with higher disability status like SPMS using a score representing disability status developed by principal component analysis from claims database
Methods
We employed principal component analysis, which is a multivariate data analysis technique, for developing a score to predict the severity of MS using the information extracted from claims data. The Medical Data Vision database (a nationwide hospital-based claims database covering all diseases) was used as a data source (2009-2018, n=7067). Diagnosis and medication codes related to 7 functional systems of EDSS were selected based on the MS treatment guideline and advice of the medical expert. Additional claims (e.g. locomotorium rehabilitation fees) which are supposed to be associated with higher disability status were also included. A score for each patient in each year was calculated based on the eigenvector coefficient for each factor of the first principal component, and then divided into 4 groups by quartile values of this score. Treatment pattern, healthcare resource utilization and costs in these 4 groups were described.
Results
The average ages were 43.3 and 55.4 years in the lowest and highest score groups, respectively. The duration since first diagnosis was 6 years for the lowest group and 8.1 years for the highest group. The total healthcare costs (JPY 102,053 vs 157,387 pppm), frequency of visit (0.69 vs 1.29 pppm) and hospitalization (0.004 vs 0.066 pppm) were numerically higher in the highest group compared with the lowest group. Meanwhile, frequency of relapse was numerically higher in the highest-score group (1.1 vs 4.1% pppm), which was counterintuitive considering natural course of MS.
Conclusions
A novel method using claims database was developed to represent MS disability status of an individual patient. This method enabled to describe the current healthcare situation of Japanese MS patients with higher disability status and demonstrated increased healthcare cost and resource utilization in this population.
P0452 - Continued increase of multiple sclerosis and neuromyelitis optica and the north-south gradient in Japan; updates from the 5th nationwide survey (ID 775)
Abstract
Background
In Japan, nationwide survey for multiple sclerosis (MS) including neuromyelitis optica spectrum disorders (NMOSD) has regularly been conducted since 1972, and the past 4 surveys conducted before the discovery of anti-aquaporin 4 antibodies demonstrated the rapid increase of MS.
Objectives
To investigate the epidemiological characteristics of MS and NMOSD in Japan simultaneously through the 5th nationwide survey.
Methods
Preliminary survey was conducted to ascertain the approximate number of patients with either MS (pwMS) or NMOSD (pwNMOSD) who had seen at the selected facilities in 2017. Preliminary survey packages were sent to departments of neurology, internal medicine, ophthalmology, and pediatrics, at the facilities randomly selected using pre-determined sampling rates stratified based on the hospital bed counts. Secondary questionnaire was sent to the facilities with the cases to collect the detailed clinical information of each patient.
Results
Out of 3,799 departments where we sent preliminary survey, 2,284 (60.1%) replied and 645 departments reported the presence of the patients with the diseases. Second questionnaire form was sent to the 645 departments for 13,067 cases, and 6,990 (53.5%) forms were returned for further analysis. Estimated number of pwMS and pwNMOSD were 24,118 in total, which is more than 10-fold higher than that (2,280) of the 1st survey in 1972. The crude prevalence for both MS and NMOSD was 19.6/100,000 (14.3 for MS and 5.3 for NMOSD). Male: female ratios of MS and NMOSD were 1: 2.2 and 1: 4.1, respectively. The onset ages (mean ± standard deviation, year) of MS and NMOSD were 32.3 ± 11.6 and 44.2 ± 16.1, respectively. The Expanded Disability Status Scale scores and disease durations were 2.7 ± 2.4 in 12.9 ± 9.0 years for MS and 3.7 ± 2.4 in 10.9 ± 9.5 years for NMOSD. Disease-modifying therapy had been used for 77.2% in MS. The proportion of pwNMOSD against pwMS was 1: 0.37. Based on the prefectures at birth, the distribution of pwMS demonstrated north-south gradient (ρ = 0.39, p = 0.008), although no significant gradient was observed in pwNMOSD. Based on the registered sites, the proportion of pwMS among both pwMS and pwNMOSD showed north-south gradient (ρ = 0.4, p = 0.004).
Conclusions
As the combined prevalence of MS and NMOSD was 7.7/100,000 in the 4th survey (4.4 for conventional MS and 3.3 for others including opticospinal form), the prevalence of both MS and NMOSD appears to be still increasing. Disease severity may have become milder in MS and NMOSD compared with the 4th survey (3.5 ± 2.9 in conventional MS and 4.3 ± 2.7 in opticospinal form), though the disease durations in the two studies were comparable. Higher latitude is a risk for MS but not NMOSD in Japanese.