Skip to main content
SpringerLink
Log in

Impact of adherence to disease-modifying therapies on clinical and economic outcomes among patients with multiple sclerosis

  • Original Research
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Background

Adherence to disease-modifying therapies (DMTs) is essential for the reduction of multiple sclerosis (MS) progression and relapse. However, only limited data currently exist on the impact of treatment adherence on MS-related clinical and economic outcomes in the real world setting.

Objective

To assess the impact of treatment adherence on MS-related hospitalizations (inpatient [INP]), ER visits, MS relapses, and medical costs.

Design/Methods

Patients with ≥1 ICD-9-CM code for MS who received ≥1 DMT between July 1, 2004 and June 30, 2008 were identified using the administrative claims database. The first DMT received during the study period was defined as the index treatment and ≥6-month preindex and ≥12-month postindex continuous health-plan enrollment were required for inclusion. Adherence was assessed using the medication possession ratio (MPR); patients with MPR ≥80% were regarded as adherent. Multivariate analyses were used to evaluate the impact of adherence on MS-related outcomes after controlling for baseline demographic and clinical characteristics.

Results

In this cohort (n=2446), 59.6% of the patients were adherent to their DMT. Compared with the nonadherent group, adherent patients were significantly less likely to have MS-related INP (odds ratio [OR]: 0.63, 95% confidence interval [CI], 0.47–0.83) and MS relapses (OR: 0.71, 95% CI, 0.59–0.85). No significant difference was found in ER risk between adherent and nonadherent groups (8.4% vs. 10.5%, P=0.068, OR: 0.80, 95% CI: 0.60–1.07). On average, the adherent group incurred lower medical costs than the nonadherent group ($3380, 95% CI, $3046–$3750 vs. $4348, 95% CI, $3828-$4940, P=0.003).

Conclusion

Treatment adherence is associated with better clinical and economic outcomes including lower risks for MS-related hospitalization, MS relapse, and less MS-related medical costs. Treatments that require infrequent administrations and have favorable adherence profiles may benefit patients who are unable to adhere to DMT therapies. Such treatments may be important in improving disease outcomes and may be suitable therapeutic candidates for the management of MS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. National Multiple Sclerosis Society [online]. 1. Available from URL: http://www.nationalmssociety.org/about-multiple-sclerosis. Accessed March 5, 2010.

  2. Frohman EM. Multiple sclerosis. Med Clin North Am. 2003;87:867–868ix.

    Article  PubMed  Google Scholar 

  3. Kantarci O, Wingerchuk D. Epidemiology and natural history of multiple sclerosis: new insights. Curr Opin Neurol. 2006;19:248–254.

    Article  PubMed  Google Scholar 

  4. Goodin DS, Frohman EM, Garmany GP, Jr., et al. Disease modifying therapies in multiple sclerosis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines. Neurology. 2002;58:169–178.

    PubMed  CAS  Google Scholar 

  5. Lubin F, Baier M, Cutter G. Effect of relapses on development of residual deficit in multiple sclerosis. Neurology. 2003;61:1528–1532.

    Google Scholar 

  6. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487–497.

    Article  PubMed  CAS  Google Scholar 

  7. Mohr DC, Goodkin DE, Masuoka L, et al. Treatment adherence and patient retention in the first year of a Phase-III clinical trial for the treatment of multiple sclerosis. Mult Scler. 1999;5:192–197.

    PubMed  CAS  Google Scholar 

  8. Ross AP. Tolerability, adherence, and patient outcomes. Neurology. 2008;71:S21–S23.

    Article  PubMed  Google Scholar 

  9. Ruggieri RM, Settipani N, Viviano L, et al. Long-term interferon-beta treatment for multiple sclerosis. Neurol Sci. 2003;24:361–364.

    Article  PubMed  CAS  Google Scholar 

  10. Patti F. Optimizing the benefit of multiple sclerosis therapy: the importance of treatment adherence. Patient Prefer Adherence. 2010;4:1–9.

    Article  PubMed  Google Scholar 

  11. Tremlett HL, Oger J. Interrupted therapy: stopping and switching of the beta-interferons prescribed for MS. Neurology. 2003;61:551–554.

    PubMed  Google Scholar 

  12. Comi G. Shifting the paradigm toward earlier treatment of multiple sclerosis with interferon beta. Clin Ther. 2009;31:1142–1157.

    Article  PubMed  Google Scholar 

  13. Flachenecker P, Rieckmann P. Early intervention in multiple sclerosis: better outcomes for patients and society? Drugs. 2003;63:1525–1533.

    Article  PubMed  Google Scholar 

  14. Andrade SE, Kahler KH, Frech F, Chan KA. Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf. 2006;15:565–574.

    Article  PubMed  Google Scholar 

  15. Cramer JA, Roy A, Burrell A, et al. Medication compliance and persistence: terminology and definitions. Value Health. 2008;11:44–47.

    Article  PubMed  Google Scholar 

  16. Castelli-Haley J, Oleen-Burkey M, Lage MJ, Johnson KP. Glatiramer acetate versus interferon beta-1a for subcutaneous administration: comparison of outcomes among multiple sclerosis patients. Adv Ther. 2008;25:658–673.

    Article  PubMed  Google Scholar 

  17. Castelli-Haley J, Oleen-Burkey MA, Lage MJ, Johnson KP. Glatiramer acetate and interferon beta-1b: a study of outcomes among patients with multiple sclerosis. Adv Ther. 2009;26:552–562.

    Article  PubMed  CAS  Google Scholar 

  18. Ollendorf DA, Jilinskaia E, Oleen-Burkey M. Clinical and economic impact of glatiramer acetate versus beta interferon therapy among patients with multiple sclerosis in a managed care population. J Manag Care Pharm. 2002;8:469–476.

    PubMed  Google Scholar 

  19. Ollendorf DA, Castelli-Haley J, Oleen-Burkey M. Impact of co-prescribed glatiramer acetate and antihistamine therapy on the likelihood of relapse among patients with multiple sclerosis. J Neurosci Nurs. 2008;40:281–290.

    Article  PubMed  Google Scholar 

  20. Steinberg SC, Faris RJ, Chang CF, et al. Impact of adherence to interferons in the treatment of multiple sclerosis: a non-experimental, retrospective, cohort study. Clin Drug Investig. 2010;30:89–100.

    Article  PubMed  CAS  Google Scholar 

  21. Roter DL, Hall JA, Merisca R, Nordstrom B, Cretin D, Svarstad B. Effectiveness of interventions to improve patient compliance: a meta-analysis. Med Care. 1998;36:1138–1161.

    Article  PubMed  CAS  Google Scholar 

  22. Klauer T, Zettl UK. Compliance, adherence, and the treatment of multiple sclerosis. J Neurol. 2008;255(Suppl. 6):87–92.

    Article  PubMed  Google Scholar 

  23. Ginsburg PB, Strunk BC, Banker MI, Cookson JP. Tracking health care costs: continued stability but at high rates in 2005. Health Aff (Millwood). 2006;25:w486–w495.

    Article  Google Scholar 

  24. Brandes DW, Callender T, Lathi E, O’Leary S. A review of disease-modifying therapies for MS: maximizing adherence and minimizing adverse events. Curr Med Res Opin. 2009;25:77–92.

    Article  PubMed  CAS  Google Scholar 

  25. Costello K, Kennedy P, Scanzillo J. Recognizing nonadherence in patients with multiple sclerosis and maintaining treatment adherence in the long term. Medscape J Med. 2008;10:225.

    PubMed  Google Scholar 

  26. Treadaway K, Cutter G, Salter A, et al. Factors that influence adherence with disease-modifying therapy in MS. J Neurol. 2009;256:568–576.

    Article  PubMed  Google Scholar 

  27. Tan H, Yu J, Tabby D, Singer J. Clinical and economic impact of a specialty care management program among patients with multiple sclerosis: a cohort study. Mult Scler. 2009;16:956–963.

    Article  Google Scholar 

  28. Saini SD, Schoenfeld P, Kaulback K, Dubinsky MC. Effect of medication dosing frequency on adherence in chronic diseases. Am J Manag Care. 2009;15:e22–33.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. HealthCore, Inc., 800 Delaware Ave., Wilmington, DE, 19801, USA

    Hiangkiat Tan, Qian Cai, Judith J. Stephenson & Siddhesh Kamat

  2. Biogen Idec, Wellesley Office Park, 45 William Street, Suite 200, Wellesley, MA, 02481, USA

    Sonalee Agarwal

Authors
  1. Hiangkiat Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qian Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sonalee Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Judith J. Stephenson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Siddhesh Kamat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiangkiat Tan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tan, H., Cai, Q., Agarwal, S. et al. Impact of adherence to disease-modifying therapies on clinical and economic outcomes among patients with multiple sclerosis. Adv Therapy 28, 51–61 (2011). https://doi.org/10.1007/s12325-010-0093-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-010-0093-7

Keywords

Search

Navigation