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One-Year Outcomes of an Integrated Multiple Sclerosis Disease Management Program

BACKGROUND: Multiple sclerosis (MS) is associated with high total health care cost, the majority of which is attributable to medications. Patients with MS are less likely to experience relapses, emergency department (ED) visits, and hospitalizations when they are adherent to disease-modifying treatm...

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Autores principales: Groeneweg, Marti, Forrester, Sara H., Arnold, Beth, Palazzo, Lorella, Zhu, Weiwei, Yoon, Paul, Scearce, Tim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Academy of Managed Care Pharmacy 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10397632/
https://www.ncbi.nlm.nih.gov/pubmed/29694287
http://dx.doi.org/10.18553/jmcp.2018.24.5.458
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author Groeneweg, Marti
Forrester, Sara H.
Arnold, Beth
Palazzo, Lorella
Zhu, Weiwei
Yoon, Paul
Scearce, Tim
author_facet Groeneweg, Marti
Forrester, Sara H.
Arnold, Beth
Palazzo, Lorella
Zhu, Weiwei
Yoon, Paul
Scearce, Tim
author_sort Groeneweg, Marti
collection PubMed
description BACKGROUND: Multiple sclerosis (MS) is associated with high total health care cost, the majority of which is attributable to medications. Patients with MS are less likely to experience relapses, emergency department (ED) visits, and hospitalizations when they are adherent to disease-modifying treatments. Disease management programs are hypothesized to improve medication adherence thereby improving clinical and economic outcomes. OBJECTIVE: To evaluate the clinical and economic effects of a specialty pharmacy and chronic disease management program for patients with MS from a health plan perspective. METHODS: This study was a retrospective analysis using prescription drug claims, medical claims, and electronic medical record information (2013-2015) 1 year before and after enrollment in the disease management program for members with 24 months of continuous health plan coverage. Medication adherence was calculated using proportion of days covered (PDC). Relapse rate was defined as an MS outpatient visit associated with a corticosteroid dispense within 7 days of the visit or an MS hospitalization. Disease progression was assessed using the Modified Expanded Disability Status Scale (mEDSS). Resource use included outpatient visits, ED visits, and hospitalizations. Cost information was collected as health plan-paid amount and was reported in 2013 U.S. dollars. RESULTS: The analysis included 377 patients (mean age 55 years, 76.4% female). After enrollment in the program, 78.7% of the study group had a PDC of ≥ 0.80 compared with 70.0% before enrollment (P < 0.001). There was no difference in MS relapse rate (0.25 after vs. 0.45 before, P = 0.11) or mEDSS score (3.77 after vs. 3.76 before, P = 0.19). Health care resource utilization was minimal and did not change significantly throughout the study period: mean outpatient visits (13.09 after vs. 13.78 before, P = 0.69); mean ED visits (0.18 after vs. 0.16 before, P = 0.60); and mean hospitalizations (0.12 after vs. 0.12 before, P = 1.00). This nonsignificant finding remained when the analysis was limited to MS-related visits only. Average annual health plan spend per patient on MS medications significantly increased ($55,835 after vs. $40,883 before, P < 0.001). CONCLUSIONS: Specialty pharmacy and chronic disease management for patients with MS can increase the proportion of patients adherent to medication. The increase in health plan spend on MS medications is not offset by savings in health care resource utilization.
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spelling pubmed-103976322023-08-04 One-Year Outcomes of an Integrated Multiple Sclerosis Disease Management Program Groeneweg, Marti Forrester, Sara H. Arnold, Beth Palazzo, Lorella Zhu, Weiwei Yoon, Paul Scearce, Tim J Manag Care Spec Pharm Research BACKGROUND: Multiple sclerosis (MS) is associated with high total health care cost, the majority of which is attributable to medications. Patients with MS are less likely to experience relapses, emergency department (ED) visits, and hospitalizations when they are adherent to disease-modifying treatments. Disease management programs are hypothesized to improve medication adherence thereby improving clinical and economic outcomes. OBJECTIVE: To evaluate the clinical and economic effects of a specialty pharmacy and chronic disease management program for patients with MS from a health plan perspective. METHODS: This study was a retrospective analysis using prescription drug claims, medical claims, and electronic medical record information (2013-2015) 1 year before and after enrollment in the disease management program for members with 24 months of continuous health plan coverage. Medication adherence was calculated using proportion of days covered (PDC). Relapse rate was defined as an MS outpatient visit associated with a corticosteroid dispense within 7 days of the visit or an MS hospitalization. Disease progression was assessed using the Modified Expanded Disability Status Scale (mEDSS). Resource use included outpatient visits, ED visits, and hospitalizations. Cost information was collected as health plan-paid amount and was reported in 2013 U.S. dollars. RESULTS: The analysis included 377 patients (mean age 55 years, 76.4% female). After enrollment in the program, 78.7% of the study group had a PDC of ≥ 0.80 compared with 70.0% before enrollment (P < 0.001). There was no difference in MS relapse rate (0.25 after vs. 0.45 before, P = 0.11) or mEDSS score (3.77 after vs. 3.76 before, P = 0.19). Health care resource utilization was minimal and did not change significantly throughout the study period: mean outpatient visits (13.09 after vs. 13.78 before, P = 0.69); mean ED visits (0.18 after vs. 0.16 before, P = 0.60); and mean hospitalizations (0.12 after vs. 0.12 before, P = 1.00). This nonsignificant finding remained when the analysis was limited to MS-related visits only. Average annual health plan spend per patient on MS medications significantly increased ($55,835 after vs. $40,883 before, P < 0.001). CONCLUSIONS: Specialty pharmacy and chronic disease management for patients with MS can increase the proportion of patients adherent to medication. The increase in health plan spend on MS medications is not offset by savings in health care resource utilization. Academy of Managed Care Pharmacy 2018-05 /pmc/articles/PMC10397632/ /pubmed/29694287 http://dx.doi.org/10.18553/jmcp.2018.24.5.458 Text en Copyright © 2018, Academy of Managed Care Pharmacy. All rights reserved. https://creativecommons.org/licenses/by/4.0/This article is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use and redistribution provided that the original author and source are credited.
spellingShingle Research
Groeneweg, Marti
Forrester, Sara H.
Arnold, Beth
Palazzo, Lorella
Zhu, Weiwei
Yoon, Paul
Scearce, Tim
One-Year Outcomes of an Integrated Multiple Sclerosis Disease Management Program
title One-Year Outcomes of an Integrated Multiple Sclerosis Disease Management Program
title_full One-Year Outcomes of an Integrated Multiple Sclerosis Disease Management Program
title_fullStr One-Year Outcomes of an Integrated Multiple Sclerosis Disease Management Program
title_full_unstemmed One-Year Outcomes of an Integrated Multiple Sclerosis Disease Management Program
title_short One-Year Outcomes of an Integrated Multiple Sclerosis Disease Management Program
title_sort one-year outcomes of an integrated multiple sclerosis disease management program
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10397632/
https://www.ncbi.nlm.nih.gov/pubmed/29694287
http://dx.doi.org/10.18553/jmcp.2018.24.5.458
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