Cost And Resource Utilization Associated with Hospitalized Multiple Sclerosis Patients

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VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8

database analysis examined patient and disease characteristics, AD treatment, and healthcare resource utilization among Medicare beneficiaries. The study included beneficiaries aged 65-100 years with 18 months continuous enrollment with medical and pharmacy benefits, a diagnosis of AD, and treatment with donepezil, galantamine, rivastigmine, or memantine; Healthcare resource utilization and costs between treated and untreated cohorts were evaluated during the 12 months prior to diagnosis (baseline period) and the 6 months following diagnosis (follow-up period).  Results: Of the total identified 9,812 incident AD patients, 57% percent (n= 5,567) received an anti-dementia therapy during follow-up; Significant differences were observed between the treated and untreated cohorts at baseline in mean age (82 vs. 85), proportion of female gender (74 vs. 77%), and mean Charlson Comorbidity index score (3.29 vs. 3.56); At both baseline and follow-up periods, untreated patients had greater healthcare resource utilization and incurred significantly higher costs compared with treated patients. During the follow-up period, the unadjusted annual total Medicare cost per patient was US$31,670 and US$39,115 for the treated and non-treated cohorts, respectively.  Conclusions: Forty-four percent of newly diagnosed patients are not treated with anti-dementia treatment during the follow-up period; Health care costs for non-treated AD patients are greater compared to treated AD patients, mainly driven by hospitalization, skilled nursing facility and hospice.

Objectives: The objective of this study was to compare the cost-effectiveness of different disease-modifying therapies (DMTs) strategies for the treatment of patients with relapsing-remitting multiple sclerosis (RRMS).  Methods: A Markov model was developed to assess the cost-effectiveness and incremental cost-effectiveness ratios (ICER) for different strategies of using DMTs from a US third-party payer perspective. The strategies were symptom management (SM) alone, SM in combination with one of the following: interferon beta-1a, natalizumab (after switching from interferon beta-1a), and alemtuzumab (after using interferon beta-1a then switching to natalizumab). The time horizon was 20 years. All costs were converted to 2014 US dollars. Different willingness-to-pay (WTP) thresholds per quality-adjusted life year (QALY) were considered in the analysis. One-way sensitivity analyses and probabilistic sensitivity analysis were conducted.  Results: Over 20 years, the total costs per patient were estimated at $161,136.60 for strategy 1 (SM alone), $551,650.66 for Strategy 2 (SM and interferon beta-1a), $703,463.60 for Strategy 3 (SM and natalizumab), and $668,806.50 for Strategy 4 (SM and alemtuzumab). The accumulated QALYs were 10.49, 10.66, 10.69, and 10.71 for each of the four strategies 1-4, respectively. The resulting ICERs were 2,297,141.53 comparing Strategy 2 to Strategy 1, 5,060,431.33 comparing Strategy 3 to Strategy 2 and -1,623,918.00, comparing Strategy 4 to Strategy 3.  Conclusions: Strategy 1 (SM alone) was the cost-effective strategy for treatment of RRMS when compared to other strategies. More studies are needed to assess the cost and effectiveness of DMTs using in MS patients.

PND17 Cost And Resource Utilization Associated with Hospitalized Multiple Sclerosis Patients

PND20 Hospitalization Cost of Chiari Malformation Type I Surgery in PediatRIC Patients

Craver CW1, Belk K2, Ernst FR3 1MedAssets, Inc., Huntersville, NC, USA, 2MedAssets, Mooresville, NC, USA, 3Indegene TTM,

Kennesaw, GA, USA

Objectives: The objective of this analysis was to describe hospital-based resource utilization among a population of patients with Multiple Sclerosis (MS) in the United States, including both inpatient and outpatient hospital services.  Methods: A retrospective cohort analysis was conducted on a crosssection of 88,679 unique patients using hospital-based inpatient and outpatient services between 2013 and 2014 with a diagnosis of MS. Multivariate logistic regression was used to evaluate drivers of resource utilization define as total patient visits and length of stay (LOS) controlling for patient and hospital characteristics as well as patient comorbidities.  Results: The mean age for MS patients was 49.9 years with 76.0% female. Utilization was highest in the OP setting (88.8%) with 68.3% of OP visits having a primary diagnosis of MS. The primary diagnosis for IP admissions varied with the most common including infectious and parasitic diseases (6.6%), cerebrovascular disease (6.2%), chronic obstructive pulmonary disease (5.5%), heart failure (5.2%) and ischemic heart disease (5.2%). MS patients were primarily treated in large (89.4%) and teaching (64.7%) hospitals. The mean Charlson comorbidity score was 0.86 (SD = 1.6) with chronic pulmonary disease (11.5%), diabetes (11.4%), plegia (4.1%), and malignancy/tumor (4.9%) as the most common comorbidities. The population averaged 2.8 (SD= 6.2) total, 2.4 (SD= 4.1) outpatient, and 0.38 (SD= 0.78) inpatient visits per patient. The overall average LOS was 3.6 (SD= 31.2) days. Congestive heart failure (RR =  1.26, CI 1.13-1.41), hemiplegia or paraplegia (RR =  1.59, CI 1.28-1.96), renal disease (RR =  1.36, CI 1.09-1.68), and dementia (RR =  1.22, CI 1.05–1.42) were associated with increased hospital LOS.  Conclusions: MS is primarily managed in the community or OP setting. As MS-related complications develop patients are admitted for IP services. Once hospitalized complications and comorbid conditions contribute to increased resource utilization as measured by increased LOS. PND18 Price Analysis of Multiple Sclerosis Disease-Modifying Drugs: Comparison Between Saudi Arabia and the United States Bin Sawad A1, Alkelya M2 1MCPHS University, Boston, MA, USA, 2King Abdullah International Medical Research Center (KAIMRC), Ryiadh, Saudi Arabia

Objectives: This study to compare prices of Multiple Sclerosis DiseaseModifying Drugs (DMDs) available in Saudi Arabia (SA) vs. that in the United States (US).  Methods: This is a cross-sectional study. All prices (in Saudi Riyal [SR]) were collected on the 2nd of January 2016. Prices of DMD per unit in SA were obtained from Saudi Food and Drug Authority (SFDA) website. Average wholesale price (AWP) per unit for DMDs in the US were derived from the RedBook (Truven Health Analytics, Inc.). The defined daily dose (DDD) for adult patients was obtained from DMD labels. Prices per DDD were computed. Descriptive statistics and Wilcoxon test were performed. Statistical significance level was set at 0.05.  Results: As of the 2ndof January 2016, there were 7 DMDs (only one oral DMD) in SA while there were 12 DMDs (3 oral DMDs) in the US. The highest DMD price per unit in SA was for natalizumab (SR 4,321.23) while it was for interferon beta-1a (EMD Serono) (SR 1,851.34) in the US. Mitoxantrone hydrochloride has the lowest DMD price per unit in both SA (SR 61.52) and the US (SR 6.87). All DMD prices in SA were lower than that in the US except for two DMDs (natalizumab and mitoxantrone hydrochloride). The median DMD price per unit in SA (median= SR 169.45, IQR= 296.38) was lower than that in the US (median= SR 891.00, IQR= 1025.59) (no statistical significant difference).  Conclusions: Most of Saudi DMD prices are lower than the US DMD prices. There was a big difference between the prices of DMDs in both countries. Price control policy adopted by SFDA is one of the contributed factors for lowering the DMD prices in Saudi Market. However, the DMD price difference between SA and the US was not statistically significant. PND19 Cost-Effectiveness of Different Strategies for Treatment of Relapsing-Remitting Multiple Sclerosis Sawad A1, Seoane-Vazquez

E1, Rodriguez-Monguio

R2, Turkistani

F1

Bin 1MCPHS University, Boston, MA, USA, 2University of Massachusetts Amherst, Amherst, MA, USA

Pan I, Mayer RR, Luerssen TG, Lam S Baylor College of Medicine/Texas Children’s Hospital, Houston, TX, USA

Objectives: The objectives of the study are to develop a cost model for hospitalization costs in pediatric Chiari Malformation Type I surgery (CM-1) and to examine risk factors for increased costs.  Methods: Data was extracted from the Healthcare Cost and Utilization Project’s Kids’ Inpatient database. The study cohort comprised patients’ age 0-20 year who had CM-1 surgery (ICD-9 CM primary diagnosis 348.4 with a procedure code 01.24 or 03.09) in 2009. Exclusion criteria were Chiari Malformation Type II diagnosis (741.0) or missing age/cost-to-charge-ratio (CCR)/ number of registered nurse FTEs. Patient charge was converted to cost by a CCR. The natural log-transform of HC was analyzed. Simple and multivariate regression were used to determine factors associated with increased costs of CM-1 surgeries. Analyses used SAS®9.4 and STATA®13.0 software.  Results: 1065 patients were included. Mean and median ages were 10.5 and 11 years. Payers included public (32.1%) and private insurers (62.0%). Patients were commonly treated in children’s units within adult hospitals (39.6%), followed by not-for-profit children’s hospitals (NCH) (29.6%). Average HC and length of stay of CM-1 were USD15,990 (range 4,02295,407, 95% Confidence Interval (CI) 15,426-16,553) and 3.8 days (range 1-48, 95%CI 3.6-3.9), respectively. Patient characteristics including age, gender, race, number of chronic diseases and procedures, and payer type had no effect on HC. Patients treated in the western US region and NCH tended to have higher costs overall. 25% patients had comorbidities. Complications were rare (medical 2.1%, surgical 5%). Patients with certain conditions were more likely to have higher HC than patients without those conditions: comorbidities (12.6% more costs), hydrocephalus (36%), syringomyelia (9.7%), medical (74%) or surgical (30%) complications.  Conclusions: Geographic practice variation, comorbidities, medical and surgical complications were significantly associated with increased HC. Further study is warranted to incorporate long-term clinical outcomes into cost models and to understand cost drivers. PND21 Antiepileptic Drug Pill Burden During the First Year Following Monotherapy Initiation Associated with Increased Epilepsy Costs in the United States Velez FF1, Korsnes JS2 1Sunovion Pharmaceuticals Inc, Marlborough, MA, USA, 2RTI Health Solutions, Research Triangle Park, NC, USA

Objectives: This study evaluated the impact of average antiepileptic drug (AED) pill burden during the year following initiation of monotherapy on epilepsy-related health care costs among patients with epilepsy in a large real-world setting in the United States.  Methods: A retrospective analysis of a large commercial claims database (January 1, 2006, to December 31, 2011) was conducted to assess average AED pill burden and its impact on epilepsy-related health care costs in adults with epilepsy. Patients aged 18-65 years with ≥ 2 epilepsy diagnoses and ≥ 2 AED prescription claims were selected for study inclusion. The first AED claim defined the index date, on which patients were required to have AED monotherapy. Patients had at least 6 and 12 months of continuous health plan enrollment before and after their index date, respectively. Generalized linear models were used to assess the relationship between average pill burden and epilepsy-related health care costs during the year following monotherapy initiation, adjusting for confounders.  Results: Of the 53,338 study patients, 6.4%, 14.7%, 31.4%, and 47.6% had an average of 0 - 1, > 1 - 2, > 2 - 3, and >  3 AED pills per day during the year following AED monotherapy initiation, respectively. Compared to those on 0-1 pills/day, adjusted annual epilepsy-related health care costs were incrementally higher among those on > 2-3, or > 3 pills/day (7.9% and 34.6%, respectively), and 15% lower among patients on > 1-2 pills. The adjusted epilepsy-related mean per-person annual health care costs were estimated at $4,885 for all patients and $3,821, $3,270, $4,792, and $5,587 for patients prescribed an average of 0 - 1, > 1 - 2, > 2 - 3, and >  3 pills per day, respectively.  Conclusions: Patients prescribed an average of fewer than 2 AED pills per day incurred lower epilepsy-related health care costs during the year following monotherapy. PND23 Projecting the Potential Cost Effectiveness of Ocrelizumab Versus Standard Care in Primary Progressive Multiple Sclerosis Patients Under Alternative Pricing Scenarios