A Qualitative Assessment of Multiple Sclerosis Patients’ Experiences with Disease Modifying Therapies

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ously for at least the previous 12 months, were identified from the 2015 Adelphi MS Disease Specific Programme, a cross-sectional study of 412 RRMS, 81 SPMPS, and 112 PPMS patients in Brazil. Regression analyses modelled the relationship between treatment with interferon beta-1a vs treatment with other platform therapies, and number of hospitalizations in the last 12 months, physician-reported treatment response and adherence to treatment. Patient age, sex, body mass index and number of comorbid conditions were included as covariates in the models.  Results: 36 patients treated with interferon beta-1a and 46 patients treated with other platform therapies were included in the analysis. Treatment with interferon beta-1a vs other platform therapies was associated with fewer hospitalizations due to relapse (-0.36, p= 0.005), increased treatment response (Odds Ratio [OR] 3.73, p= 0.008) and increased treatment adherence (OR 4.91, p= 0.005).  Conclusions: In Brazil, hospitalizations due to relapse represent a significant cost to patients and the health system, making it essential to find treatment options that help prevent inpatient stays. Injectable treatments for MS have been shown to reduce relapse rates and in turn decrease costs associated with hospitalizations. In addition, patient adherence plays a major role in achieving maximum therapeutic effect while finding medication that meets patient needs. Treatment with interferon beta-1a compared to other platform therapies was associated with a better adherence and better response as perceived by physicians, as well as fewer hospitalizations due to relapse. Using interferon beta-1a may improve adherence and response to therapy, which subsequently may reduce the number of relapse-related hospitalizations. PND35 A Qualitative Assessment of Multiple Sclerosis Patients’ Experiences with Disease Modifying Therapies Thach A1, Brown C1, Herrera V2, Sasane R3 1The University of Texas at Austin, Austin, TX, USA, 2Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, 3Novartis Pharmaceuticals, East Hanover, NJ, USA

Objectives: Optimal adherence to disease modifying therapies (DMTs) is important to maximize clinical benefits among multiple sclerosis (MS) patients. Poor adherence to DMT can lead to relapse or progression of MS, which worsens patient outcomes. This research aims to qualitatively explore patients’ experiences with DMTs to better understand complex and multifactorial causes of decreased adherence among MS patients.  Methods: Patients aged 18 years or older, diagnosed with relapsing MS, and prescribed an injectable and/or oral DMT were eligible to participate in the focus groups. Three separate focus groups, based on currently prescribed DMT (injectable, oral, and mix of injectable or oral), were conducted in Austin, TX. Three main areas of discussion were: medication burden, barriers of adherence, and coping strategies. An inductive content analysis was used to identify emergent themes from the data.  Results: Twenty-six MS patients were assigned to one of three focus groups: injectable (n= 10), oral (n= 6), or mix of injectable and oral (n= 10). Majority were female (65.4%) and Caucasian (73.1%). On average, patients were 49.6±9.2 years old and had MS for 12.3±6.6 years. Four major themes emerged: DMT-related issues, barriers of adherence, facilitators of adherence (currently used), and facilitators of adherence (desired). DMT-related issues (e.g., administration, storage) contributed to overall medication burden for patients rather than directly impacting adherence; however, several barriers and facilitators (e.g., memory, lack of motivation) directly impacted adherence. Patients utilized various strategies, such as industry-sponsored support programs and reminder devices, to improve adherence and expressed their desire for easier DMT administration and ordering processes.  Conclusions: This study identified multiple DMT-related issues, barriers of DMT adherence, and various methods and strategies employed by patients to improve adherence. Findings from this study may be used to tailor initiatives aimed at improving adherence, which may help patients realize full clinical benefits of DMT. PND36 Cost-sharing and Demand Elasticity on Disease Modifying Therapies in Multiple Sclerosis Shao H, Shi L, Stoecker C Tulane University, New Orleans, LA, USA

Objectives: Due to the trade-offs between cost-sharing, patient-perceived value and health outcomes, the relationship between cost-sharing and DMTs utilization could be much more complex than monotonous. This study aimed to examine the relationship between out-of-pocket (OOP) payments for DMTs and DMT utilization. It also explored for the existence of local optimum(s) in OOP payments with respect to the trade-off between health care utilization and cost containment.  Methods: Individuals with more than two MS diagnoses (ICD-9-CM: 340) and continuous plan enrollment were identified from the Thomson Medstat MarketScan Database (2006-2010). To avoid issues of patient selection of drugs, the OOP payment was measured based on the average OOP payment for purchasing a fixed basket of drugs at insurance plan level. We applied logistic regression on DMT utilization using OOP payment as main explanatory variable and demand elasticity was calculated based on the coefficient. We also used local linear regression to further explore the relationship between OOP payment and DMT utilization.  Results: 44,201 MS patients were identified, 21,861(49.46%) of which had used DMTs during the study period. The annual OOP payment for DMTs was $588.24, and the annual reimbursement rate was 97.88%. Demand for DMTs was inelastic with respect to price (0.001, S.E. = 0.007, p= 0.886) in general. A local linear regression identified $600 annual OOP payment as an inflection point in the relationship between price and usage. The demand elasticity for the subsample with annual OOP payment ≤  $600 was 0.023 (S.E. =  0.014, p= 0.102), and for the subsample with annual OOP payment > $600 was -0.101(S.E. =  0.035, p< 0.001).  Conclusions: While the utilization of DMTs appeared to be irresponsive to OOP payment change across the general population, our analysis detected strong non-linearities in the elasticity of demand. For annual OOP payment exceeding $600, increased OOP payments may discourage the initiation of DMTs.

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PND37 Predictors of Activities of Daily Living in Elderly Nursing Home Patients with Parkinson’s Disease Chekani F, Bali V, Aparasu R University of Houston, Houston, TX, USA

Objectives: The current study examined factors associated with activities of daily living (ADL) in patients with Parkinson’s disease (PD) residing in nursing homes in the United States.  Methods: This study used data from the National Nursing Home Survey (NNHS), a nationally representative survey of the US nursing homes and applied a retrospective cross-sectional design to achieve the study objectives. The ADL comprised of five items related to assistance needed for transferring, dressing, eating, toileting and bathing. The dependent variable, ADL was measured as a continuous measure ranging from 0-5, with a higher value indicating more assistance needed for ADL or poor functional status. Multivariable linear regression was used to examine association of individual, biological and environmental factors with ADL.  Results: According to the NNHS, there were 98,093 nursing home residents with PD. The mean age of the study sample was 81.03±0.34 years. Most of the study participants were females (62%) and whites (93%). Mean ADL score for patients with PD was 4.39±0.04. Age (β : 0.02, 95% CI: 0.01, 0.03), metropolitan statistical area (β : 0.19, 95% CI: 0.03, 0.34), prior living place (β : 0.22, 95% CI: 0.32, 0.11), and mood symptoms (β : 0.02, 95% CI: 0.09, 0.32) were associated with worsening of ADL. Marital status (β : -0.29, 95% CI: -0.40, -0.19), behavioral symptoms (β : -0.17, 95% CI: -0.34, -0.01), and levodopa combination therapy (β : -0.17, 95% CI: -0.31, -0.03) were associated with improvement of ADL.  Conclusions: Majority of the nursing home residents with PD had disability leading to some kind of assistance for ADL. Various individual, environmental and biological factors were associated with ADL in nursing home residents with PD. Knowledge of these factors can be helpful in reducing the burden of disease and in improving quality of life of nursing home residents with Parkinson’s disease. PND38 Elicitation of Utility Values in Patients with Multiple Sclerosis in South Korea CHOI YC1, LIM SJ1, Barone J2, Suh D3 1Chung-Ang University, Seoul, Korea, The Republic of, 2Rutgers University, Piscataway, NJ, USA, 3Chung-Ang University, Seoul, South Korea

Objectives: To measure utility values associated with health states of relapsingremitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS), classified by the expanded disability status scale (EDSS) system in South Korea.  Methods: Time-trade off (TTO) and visual analogue scale evaluations were used to elicit values. Information on the health states were gathered from published literature and consultation with clinical specialists. We considered adverse events (AE) such as urticaria, anaphylactoid reactions, spasticity, and rash. The selected 14 health states measured were EDSS 0, 3, 3+relapse, 4, 6, 6+relapse, 8, 8+relapse, 8+SPMS, 9, AE1(urticaria), AE2(anaphylaxis), AE3(spasticity), and AE4(rash). Trained interviewers conducted Face-to-faceace interviews of 4 groups, and stratified systematic random sampling was used in selecting samples. We used ordinary least squares (OLS) to estimate utility values that were not measured in the survey (e.g. EDSS 1). It also determined which factors influenced utility values.  Results: Individuals from the South Korean general public were recruited (n= 106). Mean age was 40.8 years (±12.8), with 61.3% females. Utility values using TTO method ranged from 0.1468 (EDSS 9) to 0.9311 (EDSS 0). The biggest decrease was between EDSS 8 to 9 (-0.2690). Age and gender did not significantly impact utility. The most influential adverse event on utility value was anaphylactoid reactions (-0.5472). A relapse in RRMS was associated with a significant decrease in utility (-0.0383). In SPMS, the utility values (-0.0975) were generally lower than those of RRMS (-0.0975). Significant differences in quality of life were found across different health states (p< 0.001).  Conclusions: The quality of life in patients with MS significantly decreased as the disease progressed until severe disability occurred. These results will be useful for conducting economic evaluations of RRMS/SPMS treatment and subsequent decision making. PND40 Psychometric Properties of the Euroqol-5-Dimensions Questionnaire (EQ-5D-3L) Among Multiple Sclerosis Caregivers Joshi N1, Khanna R1, Bentley JP1, West-Strum D1, Philips G2, Strum MW1, Barnard M1 1University of Mississippi, University, MS, USA, 2Biogen, Cambridge, MA, USA

Objectives: This study reports the results of psychometric evaluation of EuroQoL–5–Dimensions questionnaire 3 level (EQ–5D–3L) including convergent, discriminant, and known–groups validity, internal consistency reliability, and floor and ceiling effects in a population of multiple sclerosis (MS) caregivers.  Methods: A cross-sectional study design was used to administer a web-based survey in a sample of MS caregivers recruited via a MS patient registry– North American Research Committee on MS (NARCOMS). Convergent validity was examined by assessing the correlation between theoretically related domains of EQ-5D-3L, Medical Outcomes Study Short-Form Health Survey version 2 (SF-12v2), and Montgomery burden scale. Discriminant validity was assessed by examining correlation between theoretically unrelated domains of EQ-5D-3L and SF-12v2. Known-groups validity was assessed by comparing EQ-5D-3L scores among caregivers across care recipient disability using Kruskal-Wallis ANOVA. Ceiling and floor effects were assessed by determining the proportion of respondents with best (11111) and worst (33333) EQ-5D-3L score. Internal consistency reliability was calculated using Cronbach’s alpha.  Results: The mean EQ-5D-3L for the study sample was 0.830 (±0.170). One-fifth of the caregivers indicated having moderate problems in walking about (mobility) (20%) and performing usual activities (22.8%), and a third indicated being moderately anxious/ depressed (32.1%). Moderate correlations were observed between the domains of EQ-5D-3L and SF-12v2. Greater objective and subjective burden was associated with lower EQ-5D-3L-index score. Weak and insignificant associations were observed between unrelated dimensions of EQ-5D-3L and SF-12v2. Caregivers’ EQ-5D-3L-index and EQ-5D-VAS scores varied with care recipients’ MS disability status. Acceptable