Contributions
Abstract: EP1351
Type: ePoster
Abstract Category: Clinical aspects of MS - 5 Epidemiology
Background: In France there is a lack of accurate and up-to-date data on care consumption of people with multiple sclerosis (PwMS). Identification of patterns among care pathways is helpful for understanding variation of practices and optimizing comprehensive care for PwMS.
Objectives: We aimed to describe care consumption of PwMS in France and identify specific patterns using multichannel sequence analysis (MCSA), an innovative method derived from social sciences.
Methods: A random sample from French health insurance databases was analysed for the period 2007-2013. As no clinical data was available, PwMS were identified in January 2007 thanks to a three-criterion algorithm using diagnoses of hospital admissions, disease-modifying therapies (DMTs) and multiple sclerosis (MS) long disease duration status. Care consumptions of interest were: consultations with general practitioners (GPs), private neurologists, private rehabilitation physicians, nurses, physiotherapists and hospitalizations for MS. These six dimensions were analysed simultaneously and led to classifying patients into homogeneous clusters.
Results: On the whole, 543 PwMS were identified with a median follow-up duration of 7 years. The sex-ratio was 2.8 with a median age of 48 years in 2007. MCSA revealed a 5-cluster typology of care consumption. A main group (n=271, 49.9%) corresponded to young patients with a probable recent MS onset, a remitting form and low disease activity. The 124 patients (22.8%) in the second group were more often treated in hospitals (received natalizumab) with a high number of visits to physiotherapists, probably reflecting an active disease. The third group (n=61, 11.2%) was routinely followed by private neurologists and almost all treated with a DMT (85.2%) possibly in relation with a controlled disease. The fourth group (n=47, 8.7%) included patients with high motor disability having a very high contact with physiotherapists, nurses and GPs, probably linked to a progressive phenotype. A defining feature of the last group of patients (n=40, 7.4%) was that they all deceased during follow-up. They were older, presented multiple comorbidities and had frequent contacts with nursing services.
Conclusion: This pioneer study, using an innovative method in health field, gives a first overview of patterns of care consumption of PwMS in France. Our results suggest that it is possible to identify from administrative databases groups of MS patients which are clinically relevant.
Disclosure: This work was supported by the French National Agency for Medicines and Health Products Safety (ANSM).
Jonathan Roux was funded as PhD fellowship by the French National Agency for Medicines and Health Products Safety (ANSM) for this work.
Olivier Grimaud has nothing to disclose.
Emmanuelle Leray reports personal fees as speaker or consultant from Novartis and Sanofi Genzyme, outside the submitted work, and travel grants from Novartis and Roche SAS. Sources of funding in the last year came from the French ARSEP Foundation, the French National Security Agency for Medicines and Health Products, the EDMUS Foundation, and donation from Roche SAS.
Abstract: EP1351
Type: ePoster
Abstract Category: Clinical aspects of MS - 5 Epidemiology
Background: In France there is a lack of accurate and up-to-date data on care consumption of people with multiple sclerosis (PwMS). Identification of patterns among care pathways is helpful for understanding variation of practices and optimizing comprehensive care for PwMS.
Objectives: We aimed to describe care consumption of PwMS in France and identify specific patterns using multichannel sequence analysis (MCSA), an innovative method derived from social sciences.
Methods: A random sample from French health insurance databases was analysed for the period 2007-2013. As no clinical data was available, PwMS were identified in January 2007 thanks to a three-criterion algorithm using diagnoses of hospital admissions, disease-modifying therapies (DMTs) and multiple sclerosis (MS) long disease duration status. Care consumptions of interest were: consultations with general practitioners (GPs), private neurologists, private rehabilitation physicians, nurses, physiotherapists and hospitalizations for MS. These six dimensions were analysed simultaneously and led to classifying patients into homogeneous clusters.
Results: On the whole, 543 PwMS were identified with a median follow-up duration of 7 years. The sex-ratio was 2.8 with a median age of 48 years in 2007. MCSA revealed a 5-cluster typology of care consumption. A main group (n=271, 49.9%) corresponded to young patients with a probable recent MS onset, a remitting form and low disease activity. The 124 patients (22.8%) in the second group were more often treated in hospitals (received natalizumab) with a high number of visits to physiotherapists, probably reflecting an active disease. The third group (n=61, 11.2%) was routinely followed by private neurologists and almost all treated with a DMT (85.2%) possibly in relation with a controlled disease. The fourth group (n=47, 8.7%) included patients with high motor disability having a very high contact with physiotherapists, nurses and GPs, probably linked to a progressive phenotype. A defining feature of the last group of patients (n=40, 7.4%) was that they all deceased during follow-up. They were older, presented multiple comorbidities and had frequent contacts with nursing services.
Conclusion: This pioneer study, using an innovative method in health field, gives a first overview of patterns of care consumption of PwMS in France. Our results suggest that it is possible to identify from administrative databases groups of MS patients which are clinically relevant.
Disclosure: This work was supported by the French National Agency for Medicines and Health Products Safety (ANSM).
Jonathan Roux was funded as PhD fellowship by the French National Agency for Medicines and Health Products Safety (ANSM) for this work.
Olivier Grimaud has nothing to disclose.
Emmanuelle Leray reports personal fees as speaker or consultant from Novartis and Sanofi Genzyme, outside the submitted work, and travel grants from Novartis and Roche SAS. Sources of funding in the last year came from the French ARSEP Foundation, the French National Security Agency for Medicines and Health Products, the EDMUS Foundation, and donation from Roche SAS.