Study findings demonstrate the importance of interventions for multiple sclerosis therapy, such as those supporting medication adherence, adverse effect management, symptom management, and additional counseling.
For women continuing therapy for multiple sclerosis (MS) throughout pregnancy, new research suggests that adherence to their disease-modifying therapies (DMTs) can result in lower hospitalization rates and costs compared to women who discontinued their therapy.
The retrospective study, conducted by Walgreens in collaboration with AllianceRx Walgreens Prime, aimed to understand how non-adherence to DMTs affected health care costs and utilization over a 2-year period.
According to the study, an estimated 2.3 million people worldwide have MS, and women are affected 2 to 3 times as often as men. None of the common therapies for MS are approved for use during pregnancy, according to the National MS Society, although discontinuing treatment with DMTs may cause relapse. Earlier research has found that some patients do continue receiving their therapies if advised to do so by their health care provider, according to the current study.
“When it comes to pregnancy or thinking of becoming pregnant, a key discussion on the risks and benefits of DMT therapy must take place between the patient and provider,” said Kathleen Love, RN, a clinical program manager at AllianceRx Walgreens Prime, in a press release.
The researchers demonstrated in a previous study that adherence among MS patients to DMT medications can reduce both hospitalization events and their related costs, according to the press release. In the study, Heather Kirkham, PhD, MPH, director of health analytics, research, and reporting at Walgreens, said the earlier, broader study looked at all patients with MS rather than just pregnant women.
“We examined the experience of MS patients not specific to pregnancy and their health care utilization and total health care cost,” Kirkham said in the news release. “We decided to look at this subset of patients because they might have a different experience. In the broader study, we did see a relationship between patients who are more adherent having a lower total health care cost.”
Using Market Scan commercial claims data over a 3-year period from 2014 to 2017, the research team identified MS-diagnosed women and followed their pattern of treatment from outpatient and inpatient visits, as well as DMT therapy, over 2 consecutive years. They created cohorts for those who received pregnancy services in the first or second year of follow-up, according to their DMT utilization. With a DMT medication adherence metric, the team identified patients as adherent to DMT in just 1 of the years or for both years.
“This was a retrospective observational study, with levels of patient DMT adherence segmented into number of years adherent or not, with outcomes on total adjusted medical costs (inpatient or outpatient non-maternity services), DMT costs and associated MS medication costs,” said Francis Staskon, PhD, senior analyst of health analytics, research, and reporting at Walgreens, in the press release.
According to the study results, among the women who utilized maternity services, 82.7% were in the first-year follow-up period. Of the 500 first-year pregnancies, 79% discontinued DMT utilization into their second year. Analysis of 603 patients’ DMT utilization found that 9.2% were adherent in both years, 39.9% were adherent in 1 year, and 53.9% were non-adherent in both years.
Furthermore, comorbidities such as diabetes or chronic pulmonary disease were present among 48 patients. Patients who were consistently adherent had significantly lower adjusted medical costs compared to consistently non-adherent patients or those with mixed adherence.
According to Staskon, these findings demonstrate that pregnant women with MS typically reduce their DMT medication adherence, but a significant number do continue treatment and demonstrate good adherence levels. Notably, average non-maternity medical costs for adherent patients were significantly lower compared to other 2 DMT non-adherent or discontinued patient groups.
The study findings also validate the importance of clinical interventions, such as those that support medication adherence, adverse effect management, symptom management, and additional counseling or information that can be provided by pharmacists.
“MS is so unpredictable and unique per individual,” Love said in the press release. “There are so many choices now for patients with MS, and a very key component in therapy along the continuum of their life is their discussion about their DMT with their prescriber.”
Study demonstrates adherence to disease-modifying therapies in pregnant MS patients can reduce hospitalization events [news release]. AllianceRx Walgreens Prime; March 1, 2021. https://alliancerxwp.com/contents/press-releases/study-demonstrates-adherence-to.html. Accessed March 4, 2021.