Author Of 2 Presentations
P0451 - Comparing infection-related outcomes in patients with multiple sclerosis and matched controls using administrative claims data (ID 925)
Abstract
Background
Few population-level risk estimates of infections in patients with multiple sclerosis (MS) exist in the United States.
Objectives
To evaluate the odds of infections associated with MS using the IQVIA™ RWD Adjudicated Claims–US database (1/1/2010–6/30/2019).
Methods
Patients with MS with ≥2 diagnoses (ICD-9-CM/ICD-10-CM: 340.xx/G35) ≥30 days apart were identified. Individuals in the non-MS cohort were required to have 2 diagnoses for any condition. A randomly selected index office visit date meeting the following criteria was selected: index age 18-64, continuous 12-month eligibility pre/post, no pregnancy claims, no antibiotic/antiviral claim 60 days prior, no inpatient residential care/end-stage renal disease facility, and no HIV/HCV. Patients with and without MS were matched 1:1 on age, sex, payer type, Census region, and index year. Infections were defined as likelihood of presence of antibiotics/antivirals claims and inpatient hospitalizations in the 12-month post-index period. Multivariable logistic regression models were used to measure the association of MS diagnosis with presence of antibiotic/antiviral claims and inpatient hospitalizations for infections. Explanatory variables were: age group, sex, payer type, region, index year (2011-2018), and select comorbidities.
Results
A total of 87,755 patients with MS met study inclusion criteria and were matched to 87,755 patients without MS. Mean (SD) age was 47.3 (10.5) years, 75.7% were female, 65.7% had commercial insurance, and 34.3% had self-insured employer insurance. Patients were from the South (32.7%), Midwest (31.3%), Northeast (25.5%) or West (10.5%) regions. Most common outpatient diagnoses of infections in both cohorts were urinary tract infection, acute sinusitis, acute upper respiratory tract infections, acute pharyngitis, and mycoses. A greater proportion of patients with MS vs. without MS had presence of antibiotic/antiviral claims (53.8% vs. 48.2%; p<0.0001) and inpatient hospitalization for infections (3.2% vs. 1.3%; p<0.0001). Compared with the non-MS cohort, patients with MS had significantly higher odds of an antibiotic/antiviral claim (adjusted odds ratio [AOR], 95% confidence interval [CI]: 1.18 [1.16, 1.20]) and significantly higher odds of inpatient hospitalization (AOR, 95% CI: 2.00 [1.86, 2.15]).
Conclusions
These findings highlight the increased odds of infection among the commercially and self-insured patients with MS in the US.
P1052 - Real-world patient-level costs of administering infusion disease-modifying drugs: a US retrospective claims database analysis (ID 332)
Abstract
Background
There is limited research regarding the overall costs of administering infusion disease-modifying drugs (DMDs) in patients with multiple sclerosis (MS).
Objectives
The purpose of this study was to evaluate the real-world per-patient per-day costs of administering MS infusion DMDs.
Methods
Patients from the IQVIA™ RWD Adjudicated Claims–US database with a diagnosis of MS (ICD-9-CM/ICD-10-CM: 340.xx/G35) and ≥1 Healthcare Common Procedure Coding System (HCPCS) billed medical claims for an infusion DMD (natalizumab, alemtuzumab, or ocrelizumab) from 1/1/2017–9/30/2018 were identified. Inclusion criteria were age 18–65 years and ≥12 months pre-index eligibility (index=first infusion claim). Patients with infusion DMDs during <12-month pre-index, a DMD that was billed as National Drug Code (NDC) claim, or DMD costs or administration costs potentially out-of-range were excluded from analyses. Medical codes (ie, HCPCS, Current Procedural Terminology [CPT] and Revenue) billed on the same day as a HCPCS-coded infusion DMD claim were included. Medical codes were categorized as administration, co-administration (eg, pre-treatment steroid, antihistamine, pregnancy test, lab tests, etc), MS-related, potentially MS-related, and not MS-related. The primary outcome was the average non-DMD cost per patient by cost category and by DMD.
Results
3236 patients treated with infusion DMDs were included in the study (natalizumab: 737 [22.8%]; ocrelizumab: 2207 [68.2%]; alemtuzumab: 292 [9.0%]). Mean total non-DMD costs for all medical codes billed on infusion-day were $1308 for alemtuzumab, $902 for ocrelizumab, and $597 for natalizumab. Costs for administration per patient were $1178 for alemtuzumab, $808 for ocrelizumab, and $468 for natalizumab. The next most costly categories were co-administration (alemtuzumab $93, ocrelizumab $63, natalizumab $54), MS-related (alemtuzumab $6, ocrelizumab $20, natalizumab $27), potentially MS-related (alemtuzumab $19, ocrelizumab $5, natalizumab $20), and unrelated (alemtuzumab $13, ocrelizumab $6, natalizumab $26). Costs billed on days other than the day of infusion administration were not included due to uncertainty regarding their relevance; therefore, cost estimates may be conservative.
Conclusions
Costs associated with administering infusion DMDs among patients with MS in the US should be considered in economic analyses. Challenges exist in setting rules for specificity and sensitivity (eg, time frame, code categorization, etc) for capturing appropriate costs.