Contributions
Abstract: P1035
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Economic burden
Background: Reducing relapses and disease progression are key treatment goals in multiple sclerosis (MS). Cohort studies and registries increasingly provide longer-term, real life data on treatment outcomes. The objective of this study was to describe changes in disability status (EDSS) and health care consumption over the period 2008-2015 through the combination of two Czech cost-of illness studies1, 2with data from an MS Centre database.
Methods: There were 426 patients in the combined dataset with a mean observation time of 8.3 years. For each patient time was segmented according to start- and end dates of treatment periods; periods of combination therapy were allocated to the most intense treatment received. A Cox proportional hazards model with time-varying covariates for treatment, disease course and EDSS was applied to estimate the effect of treatment on the risk of progression to EDSS 4 and the risk of relapses. To account for time-varying confounding, observations were weighted according to the inverse probability of receiving the allocated treatment. The use and cost of health care resources (hospitalisation, consultation, tests) was compared between the two cross-sectional studies.
Results: Total health care costs were lower in 2015 compared to 2008, in spite of the more intense use of MS treatments (52% versus 31%). Of 311 patients with EDSS 0-3 at baseline, 39% progressed to EDSS 4 or higher during follow-up. 70% of patients starting treatment at EDSS 0-2 remained stable, while 70% of those starting at EDSS 3 progressed to 4 or higher.
The number of relapses during the previous year was associated with a higher risk of progression. In a marginal structural Cox model of the relapse risk, treatment with natalizumab or fingolimod was associated with a lower risk of relapse (hazard ratio 0.68, p< 0.01). Treatment with natalizumab or fingolimod was associated with a lower risk of progression to EDSS 4 (hazard ratio 0.45, p=0.07 in the IPTW weighted analysis, HR 0.36 p=0.02 in the unweighted analysis).
Conclusion: Changes in costs cannot be explained by changes in disease status alone, but likely relate to changes in patient management. The analysis of the treatment effect is complicated by the small sample size, the administrative rules guiding treatment and thus the absence of a random comparator group. Despite of this, our results link relapses to progression and indicate that the newer treatments may have better effectiveness.
Disclosure: The analysis has been financially supported with a grant to European Health Economics AB Stockholm.
G Kobelt has provided consulting and speaking services to from Almirall, Bayer, Biogen, Merck Serono, Novartis, Oxford PharmaGenesis, Roche, Sanofi Genzyme and Teva.
L Jönsson is employed by H. Lundbeck and has provided consulting and advisory services to Ipsen, Pfizer, Merck, Sanofi and Biogen.
M Pavelkova has no financial disclosures
E Kubala Havrdova has received personal compensation for consulting and speaking for Actelion, Biogen, Celgene , Merck, Novartis, Sanofi, Roche, and Teva, and is supported by Czech Ministry of Education, project PROGRES Q27/LF1
Abstract: P1035
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Economic burden
Background: Reducing relapses and disease progression are key treatment goals in multiple sclerosis (MS). Cohort studies and registries increasingly provide longer-term, real life data on treatment outcomes. The objective of this study was to describe changes in disability status (EDSS) and health care consumption over the period 2008-2015 through the combination of two Czech cost-of illness studies1, 2with data from an MS Centre database.
Methods: There were 426 patients in the combined dataset with a mean observation time of 8.3 years. For each patient time was segmented according to start- and end dates of treatment periods; periods of combination therapy were allocated to the most intense treatment received. A Cox proportional hazards model with time-varying covariates for treatment, disease course and EDSS was applied to estimate the effect of treatment on the risk of progression to EDSS 4 and the risk of relapses. To account for time-varying confounding, observations were weighted according to the inverse probability of receiving the allocated treatment. The use and cost of health care resources (hospitalisation, consultation, tests) was compared between the two cross-sectional studies.
Results: Total health care costs were lower in 2015 compared to 2008, in spite of the more intense use of MS treatments (52% versus 31%). Of 311 patients with EDSS 0-3 at baseline, 39% progressed to EDSS 4 or higher during follow-up. 70% of patients starting treatment at EDSS 0-2 remained stable, while 70% of those starting at EDSS 3 progressed to 4 or higher.
The number of relapses during the previous year was associated with a higher risk of progression. In a marginal structural Cox model of the relapse risk, treatment with natalizumab or fingolimod was associated with a lower risk of relapse (hazard ratio 0.68, p< 0.01). Treatment with natalizumab or fingolimod was associated with a lower risk of progression to EDSS 4 (hazard ratio 0.45, p=0.07 in the IPTW weighted analysis, HR 0.36 p=0.02 in the unweighted analysis).
Conclusion: Changes in costs cannot be explained by changes in disease status alone, but likely relate to changes in patient management. The analysis of the treatment effect is complicated by the small sample size, the administrative rules guiding treatment and thus the absence of a random comparator group. Despite of this, our results link relapses to progression and indicate that the newer treatments may have better effectiveness.
Disclosure: The analysis has been financially supported with a grant to European Health Economics AB Stockholm.
G Kobelt has provided consulting and speaking services to from Almirall, Bayer, Biogen, Merck Serono, Novartis, Oxford PharmaGenesis, Roche, Sanofi Genzyme and Teva.
L Jönsson is employed by H. Lundbeck and has provided consulting and advisory services to Ipsen, Pfizer, Merck, Sanofi and Biogen.
M Pavelkova has no financial disclosures
E Kubala Havrdova has received personal compensation for consulting and speaking for Actelion, Biogen, Celgene , Merck, Novartis, Sanofi, Roche, and Teva, and is supported by Czech Ministry of Education, project PROGRES Q27/LF1