Author Of 2 Presentations
P0498 - The effect of national disease modifying therapy subsidy policy on long-term disability outcomes in people with multiple sclerosis (ID 1652)
Disease-modifying therapies (DMT), which modify, mediate or suppress the immune system, are a major medication class for treating people with relapsing-onset multiple sclerosis (MS). However, our knowledge about these medications is largely limited to their short-term effects.
To determine: 1) the impact of national-level DMT subsidy policy on DMT use and disability in people living with MS (PwMS); and 2) the long-term effects of DMT on disability (EDSS and MSSS) and quality of life (EQ5D5L utility score).
This project was an ecological, observational cohort study comparing populations in Australia and New Zealand with similar demographics, but markedly different levels of DMT use 10-20 years post-diagnosis. Differences between countries were assessed using standardized differences (Cohen’s d), phi coefficient and Cramer’s V. Associations were assessed with univariable and multivariable (mediation) linear regression models.
We recruited 328 Australian participants, 93.9% of whom had been treated with DMT, and 256 New Zealand participants, 50.4% of whom had been treated with DMT. The Australian cohort had a longer median treatment duration (148 vs 0 months), greater proportion of disease course treated (86% vs 0%), and shorter time between diagnosis and first DMT (3 vs 24 months). The Australian cohort also had lower median EDSS (3.5 vs 4.0) and MSSS (3.05 vs 3.71), and higher quality of life (0.71 vs 0.65) at follow-up. In multivariable models, differences in DMT use significantly mediated the effect of country on disability and quality of life.
This large ecological study provides evidence for the impact of national level policy on DMT use and subsequent disability outcomes in PwMS. It also demonstrates that the protective effect of DMT may mediate the effect of national policy on disability progression and quality of life 10-20 years post-diagnosis in people with relapsing-onset MS.
P1037 - Impact of remoteness on patient-reported outcomes in Australians with multiple sclerosis (ID 1550)
Inequity in the availability and quality of health care may exist across geographical locations. Little is known about whether living in remote areas is associated with worse health outcomes in Australians with multiple sclerosis (MS), which is important information for health care planning.
We aimed to evaluate whether living in regional or remote areas was associated with worse disease outcomes, employment outcomes, health-related quality of life (HRQoL), disease modifying therapy (DMT) utilisation and cost of illness among Australians with MS.
Around 3000 participants of the Australian MS Longitudinal Study were invited to participate in three surveys in 2016. Level of remoteness (major cities, inner regional, outer regional, remote and very remoted Australia) was determined using postcode. Information on MS type, DMT use, HRQoL, severity of 13 MS symptoms, disability and employment outcomes were collected. Data were analysed using linear regression, log-binomial regression, log-multinomial regression and negative binomial regression.
Living in more remote areas was not associated with substantially worse health/employment outcomes, or higher MS costs among Australians with MS. There was a consistent pattern of those living in inner regional areas having slightly worse health outcomes and higher costs, but the effect sizes were relatively small and there were no clear dose-response relationships with increasing remoteness. They were also less likely to use high efficacy DMTs compared to those living in major cities. Adjusting for factors such as age, disease duration, and education level only marginally reduced the associations.
There is no large inequity in outcomes within the Australian MS population as a result of remoteness, although those living in inner regional areas had slightly worse health outcomes and higher MS costs.