Contributions
Abstract: EP1425
Type: ePoster
Abstract Category: Clinical aspects of MS - 9 Economic burden
Background: Corticosteroids (CS) are the mainstay treatment of relapses in patients with multiple sclerosis (MS); other agents include repository corticotropin injection (RCI; H.P. Acthar® Gel), intravenous immunoglobulin (IVIG), or plasmapheresis (PMP). Our study evaluated patients with MS relapse, healthcare resource use (HCRU), and effectiveness of CS alternatives in relapse resolution using the Humana Research Database. Humana policy considers CS to be first-line relapse therapy.
Methods: Humana's Commercial and Medicare Advantage claims data from 1/1/08-7/31/15 were utilized. An MS relapse was defined as an inpatient stay (IP) with a principal diagnosis of MS (ICD-9-CM 340.xx) or an outpatient visit [OP, including emergency department (ED)] with a MS diagnosis, and a medical or pharmacy claim for second-line treatment (RCI, IVIG, PMP) within 30 days. The first relapse event and treatment were considered the index event and treatment. Relapse events were considered unresolved if >1 relapse occurred within 30 days. In RCI and PMP/ IVIG groups, relapse events and HCRU (IP, OP, ED, total visits) were evaluated during 1-year follow-up (1 year); relapse events were also evaluated during 2-year follow-up (2 years). Comparative analyses were conducted, using chi-square tests for categorical variables and t-tests for continuous variables.
Results: PMP and IVIG were combined into 1 group, due to sample size. At 1 year, 232 RCI and 141 PMP/IVIG patients were identified with mean (SD) unresolved relapse events of 0.6 (2.0) and 5.3 (7.1), respectively. 81.5% of patients receiving RCI had no unresolved relapses vs. 36.2% receiving PMP/IVIG. Patients receiving RCI had lower all-cause HCRU, except ED (mean differences): total visits (12.9), IP (0.2), ED (0.0), and OP (12.7). At 2 years, 155 RCI and 104 PMP/IVIG patients were identified with mean (SD) unresolved relapses of 1.2 (3.5) and 8.0 (11.6), respectively. 73.5% of patients receiving RCI had no unresolved relapses vs. 33.7% receiving PMP/IVIG. All results, except for ED visits, were significant at p< 0.02.
Conclusions: At 1 year, patients receiving RCI had significantly lower unresolved relapses and lower mean total, IP, and OP visits; superior resolution with RCI continued at 2 years. Results suggest RCI should be considered for relapse treatment prior to PMP/IVIG in appropriate patients. Limitations of claims data apply; index events were first observed and not incident.
Disclosure: This study was funded by Mallinckrodt Pharmaceuticals, Inc.
Manasi Datar: A shareholder of Humana Inc. and an employee of Comprehensive Health Insights, Inc., a wholly-owned subsidiary of Humana Inc.
Richard Sheer: A shareholder of Humana Inc. and an employee of Comprehensive Health Insights, Inc., a wholly-owned subsidiary of Humana Inc.
Phil Schwab: A shareholder of Humana Inc. and an employee of Comprehensive Health Insights, Inc., a wholly-owned subsidiary of Humana Inc.
Tara Nazareth: An employee and stock holder of Mallinckrodt Pharmaceuticals, Inc.
Tzy-Chyi Yu: An employee and stock holder of Mallinckrodt Pharmaceuticals, Inc.
Abstract: EP1425
Type: ePoster
Abstract Category: Clinical aspects of MS - 9 Economic burden
Background: Corticosteroids (CS) are the mainstay treatment of relapses in patients with multiple sclerosis (MS); other agents include repository corticotropin injection (RCI; H.P. Acthar® Gel), intravenous immunoglobulin (IVIG), or plasmapheresis (PMP). Our study evaluated patients with MS relapse, healthcare resource use (HCRU), and effectiveness of CS alternatives in relapse resolution using the Humana Research Database. Humana policy considers CS to be first-line relapse therapy.
Methods: Humana's Commercial and Medicare Advantage claims data from 1/1/08-7/31/15 were utilized. An MS relapse was defined as an inpatient stay (IP) with a principal diagnosis of MS (ICD-9-CM 340.xx) or an outpatient visit [OP, including emergency department (ED)] with a MS diagnosis, and a medical or pharmacy claim for second-line treatment (RCI, IVIG, PMP) within 30 days. The first relapse event and treatment were considered the index event and treatment. Relapse events were considered unresolved if >1 relapse occurred within 30 days. In RCI and PMP/ IVIG groups, relapse events and HCRU (IP, OP, ED, total visits) were evaluated during 1-year follow-up (1 year); relapse events were also evaluated during 2-year follow-up (2 years). Comparative analyses were conducted, using chi-square tests for categorical variables and t-tests for continuous variables.
Results: PMP and IVIG were combined into 1 group, due to sample size. At 1 year, 232 RCI and 141 PMP/IVIG patients were identified with mean (SD) unresolved relapse events of 0.6 (2.0) and 5.3 (7.1), respectively. 81.5% of patients receiving RCI had no unresolved relapses vs. 36.2% receiving PMP/IVIG. Patients receiving RCI had lower all-cause HCRU, except ED (mean differences): total visits (12.9), IP (0.2), ED (0.0), and OP (12.7). At 2 years, 155 RCI and 104 PMP/IVIG patients were identified with mean (SD) unresolved relapses of 1.2 (3.5) and 8.0 (11.6), respectively. 73.5% of patients receiving RCI had no unresolved relapses vs. 33.7% receiving PMP/IVIG. All results, except for ED visits, were significant at p< 0.02.
Conclusions: At 1 year, patients receiving RCI had significantly lower unresolved relapses and lower mean total, IP, and OP visits; superior resolution with RCI continued at 2 years. Results suggest RCI should be considered for relapse treatment prior to PMP/IVIG in appropriate patients. Limitations of claims data apply; index events were first observed and not incident.
Disclosure: This study was funded by Mallinckrodt Pharmaceuticals, Inc.
Manasi Datar: A shareholder of Humana Inc. and an employee of Comprehensive Health Insights, Inc., a wholly-owned subsidiary of Humana Inc.
Richard Sheer: A shareholder of Humana Inc. and an employee of Comprehensive Health Insights, Inc., a wholly-owned subsidiary of Humana Inc.
Phil Schwab: A shareholder of Humana Inc. and an employee of Comprehensive Health Insights, Inc., a wholly-owned subsidiary of Humana Inc.
Tara Nazareth: An employee and stock holder of Mallinckrodt Pharmaceuticals, Inc.
Tzy-Chyi Yu: An employee and stock holder of Mallinckrodt Pharmaceuticals, Inc.