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Greater DMT Use Associated With a Drop in Hospitalizations for Patients With MS

Maggie L. Shaw
The first disease-modifying therapies were introduced in the United States and Canada in the 1990s.
Canada has one of the highest estimated prevalences of multiple sclerosis (MS) in the world, equating to total annual costs of almost $950 million in 2001. This number is expected to more than double by 2031 to $2 billion, a significant financial strain imposed by the disease from its long-term nature and significant treatment costs, especially disease-modifying therapies (DMTs).

With conflicting results from previous studies on the cost-effectiveness of DMTs, a group of researchers in Saskatchewan and Manitoba, Canada, used data from Saskatchewan government health administrative databases to investigate healthcare utilization rates at the population level for patients with MS on DMTs versus the general population in Saskatchewan, hoping to shape future healthcare policy decisions on therapy reimbursement and coverage. Their results appeared in a recent issue of BMJ Open.

All patients in both cohorts were at least 18 years old. The general population cohort comprised drug plan beneficiaries, while the MS group were identified by there being at least 3 claims for a hospital stay, physician visit, or medication. Only DMT dispensations that occurred between January 1, 1997, and December 31, 2016 were included, with the same period used to assess hospitalization and physician claims. And the authors tested for the impact of yearly DMT dispensations on 3 measures:
  1. total inpatient hospitalizations (MS and all-cause)
  2. mean length of all-cause inpatient hospitalizations
  3. yearly physician claims (MS and all-cause)
 

Despite 159,396 DMT dispensations over the study period, hospitalization rates decreased for both cohorts, with the drop greater among the MS cohort. Also, although increases were seen in the mean lengths of stay for both all-cause and MS-specific hospitalizations, non-MS claims were constant. For the 3 measures of yearly DMT dispensations impact, there was a drop in risk, the mean length increased but was considered insignificant, and no association was recorded, respectively, with an increase in DMT use.

They authors do not view this in a negative light, though, because their results match those of previous studies of patients with MS in the United States and Canada, where greater DMT use correlated with drops in inpatient hospitalizations, emergency department visits, and intensive care unit admissions.

Their outcomes do, however, need to be considered in light of several study limitations. The analyses did not cover Registered First Nations and Inuit people in Saskatchewan, whose drug costs are covered by another government agency; they could not account for all potential confounders; and administrative data do not include clinical details that could have influenced the results.

“Additional research on cost-benefit and differing treatment strategies would provide further insight into the true impact of DMTs on healthcare utilization at a population level,” the investigators recommend.

Reference

Al-Sakran, Marrie RA, Blackburn D, Knox K, Evans C. Association between disease-modifying therapies for multiple sclerosis and healthcare utiliation on a population level: a retrospective cohort study. BMJ Open. 2019;9:e033599. doi: 10.1136/bmjopen-2019-033599.

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