Slowing the rate of decline

MS patients who adhere to treatment have higher health costs—and better outcomes

A JAOA study offers evidence that costly medications are effective in slowing the progression of multiple sclerosis.


Researchers examined the insurance claims and medical records of 681 patients with multiple sclerosis (MS) and found those who adhered to medication schedules had significantly better physical outcomes than patients who did not, although the total overall costs for their care were higher.

The findings, published in the December edition of The Journal of the American Osteopathic Association, are considered significant because it is harder to assess treatment results for patients with MS than for those with other chronic illnesses, making it difficult to determine whether the treatment benefits justify their cost.

Researchers noted that the disease has few easily obtainable objective measures, like blood pressure or glucose levels. For patients with MS, disease activity is primarily measured through imaging studies, which can identify new lesions in the event of a relapse. Those studies are expensive and aren’t routinely performed or captured in a quantitative fashion.

Meds slow rate of decline

“Payers often look at near-term improvement to determine whether a treatment is effective and worth the cost,” says Carl Hoegerl, DO, a neurologist at the Liberty University College of Osteopathic Medicine and a co-researcher on this study. “But the case for MS treatment becomes evident when you see that the rate of decline becomes much slower and less severe.”

Comparing the experiences of MS patients with high adherence to treatments to those with low adherence, the study found patients with highest adherence reported the disease’s physical impact as 14 percent less severe and the psychological impact 17 percent less severe. Patients with high adherence also rated their level of disability 12 percent lower and believed their treatments to be 7 percent more effective.

Dr. Hoegerl said that patients with untreated MS face a sharper decline in their ability to walk and move. They can also experience pain, numbness and tingling in their extremities.

More on MS

MS is the most common cause of neurologic disability in adults, with about 135 cases per 100,000 Americans. About 12,000 new cases of MS are reported annually. While there is no cure, 12 FDA-approved treatments are currently available for patients with the disease.

“I’m focused on partnering with patients to achieve their health goals, which for most MS patients involves maintaining their physical functions for as long as possible,” said Dr. Hoegerl. “We know that proper treatment of MS improves the quality of patients’ lives and extends them to almost the length of the average person.”

The study was conducted at Geisinger Health System, an integrated delivery system in central and northeastern Pennsylvania that includes an insurance provider, Geisinger Health Plan. The study included adults whose records included MS diagnostic codes and medication orders for MS therapies.

The two-phase study of patients from January 1, 2004, to December 31, 2013, included a retrospective analysis of electronic health records and insurance claims plus a prospective analysis of self-reported medication adherence. The health outcomes considered included inpatient admission, emergency room visits, outpatient appointments and health care costs. All-cause versus MS-related costs were calculated separately, with all costs adjusted for inflation to 2013 dollars.

To learn more, read the full study in The JAOA.

Editor’s Note: The authors reported no financial disclosures. This study was supported by an institutional research grant from Biogen.

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