Nonadherence to Disease-Modifying Treatment in MS Has Significant Clinical and Economic Effects

Jacqueline Nicholas, MD, MPH

The economic and clinical burden of medication nonadherence in multiple sclerosis (MS) can be significant, according to findings presented at the 2019 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), May 28-June 1, in Seattle, Washington.¹

Adherence to disease-modifying treatment (DMT) regimens in MS is suboptimal, with previous research reporting discontinuation or non-adherence rates of nearly 30% in patients with MS taking oral DMTs.²

In order to better understand the clinical and economic impacts of this behavior, investigators led by Jacqueline Nicholas, MD, MPH, of Ohio Multiple Sclerosis Center in Columbus, conducted a cost-consequence analysis among patients taking once- or twice-daily DMTs.

The systemic literature review and meta-analysis included 5 studies comprising 3786 patients. The investigators used these data to construct a 1-year health economic cost-consequence analysis model to predict the clinical and economic burden of DMT nonadherence in 1000 patients with MS. Outcomes included in the analysis were: relapses, hospitalizations, emergency room (ER) visits, outpatient visits, days of work lost, and direct and indirect costs.

Data from the meta-analysis was used to calculate a pooled 1-year mean proportion of days covered of 76.5%. Based on a common threshold for nonadherence (proportion of days covered <0.8), pooled adherence for the meta-analysis was 71.8%.

Based on the cost-consequence model analysis of 1000 patients with MS receiving once- or twice-daily oral DMTs, nonadherence was found to be responsible for 16 to 36 MS relapses; 10 to 36 hospitalizations; 13 to 70 ER visits; 127 to 286 outpatient visits; 2835 to 4200 days of work lost; $807,030 to $2,378,744 in direct costs; and $302,400 to $448,000 in indirect costs over 1 year.

“Findings from this CCA model indicate that the clinical and economic burden of nonadherence among patients with MS taking once- or twice-daily oral DMDs can be considerable,” the investigators concluded. “Treatment options with improved adherence may result in reduced resource use and related costs.”

REFERENCES

1. Nicholas J, Edwards NC, Dellarole A, Harlow DE, Phillips AL. Clinical and economic burden of nonadherence to oral disease-modifying drugs in patients with multiple sclerosis: a cost-consequence model. Presented at: 2019 CMSC Annual Meeting. May 28-June 1, 2019; Seattle, WA. Abstract DXT38.

2. Burks J, Marshall TS, Ye X. Adherence to disease-modifying therapies and its impact on relapse, health resource utilization, and costs among patients with multiple sclerosis. Clinicoecon Outcomes Res. 2017;9:251-260. doi: 10.2147/CEOR.S130334.