Abstract Details

Title Assessing Presence of MS-related Symptoms as a Proxy for Disease Severity in Multiple Sclerosis Using Administrative Claims Data

Topic Multiple Sclerosis

Presentation(s) MS and CNS Inflammatory Disease Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 241

Objective To assess multiple sclerosis (MS)-related symptoms as a proxy for disease severity using administrative claims data and examine comorbidities and direct medical costs across severity categories.

Background Healthcare claims data lack clinically relevant variables such as disease severity.

Design/Methods Published literature informed a mapping exercise with a clinical expert to identify MS-related symptoms using diagnostic/medication/healthcare procedural codes. Patients were categorized as mild/moderate/severe based on a combination of the following post-index symptoms: bladder/bowel (urinary/stool incontinence, visit to urologist, etc.), psychiatric (anxiety/depression), cognitive (dementia/cognitive impairment), and physical function (spasticity, wheelchair/cane/walker use, etc.). The proxy measure was applied to US Workpartners’ claims data (1/1/2010–12/31/2019). Eligibility criteria were: ≥3 MS-related (ICD-9-CM/ICD-10-CM: 340.xx/G35) inpatient, outpatient, or MS disease-modifying therapy (DMT) claims within a one-year period (latest claim=index date); continuous enrollment 6-months pre-/1-year post-index; and age 18–64. Demographic and clinical characteristics (not included in the proxy assessment) and direct medical and pharmacy costs were compared across severity categories.

Results The 1041 eligible patients were classified as mild (n=358 [34.4%]), moderate (n=491 [47.2%]), and severe (n=192 [18.4%]). Mean (standard error [SE]) age distribution was: mild 47.9(0.5); moderate 49.7(0.4); severe 50.7(0.7). Mean Charlson Comorbidity Index scores were: mild 0.40(0.05); moderate 0.68(0.06); severe 1.12(0.13; all p<0.001). The proportion with gastrointestinal disease (mild/moderate/severe: 14.2%/26.1%/43.2%), arthritis (mild/moderate/severe: 5.9%/9.8%/15.1%), and hypertension/hyperlipidemia/diabetes (mild/moderate/severe: 27.7%/38.5%/49.5%) increased with severity (all p<0.05). A greater proportion with moderate/severe vs. mild disease had substance abuse disorder (mild/moderate/severe: 1.7%/4.3%/5.2%; both p<0.05), chronic pain syndrome (mild/moderate/severe: 1.7%/4.5%/5.2%; both p<0.05), and chronic lung disease (mild/moderate/severe: 4.5%/12.4%/13.5%; both p=0.0001). Mean (SE) direct medical costs increased with severity (mild $9923[$1421], moderate $21,326[$2248], severe $36,876[$5058]; all p<0.005). Patients had higher non-DMT pharmacy costs with moderate ($34,912[$1779]; p<0.0001) and severe ($31,856[$2793]; p=0.0021) vs. mild ($29,130[$2027]) disease.

Conclusions

Preliminary findings showed that comorbidities and direct medical/non-DMT costs increased with severity. Further validation of this proxy measure is needed.

Authors/Disclosures
Carroline Lobo, PhD (EMD Serono Inc. - Rockland, MA) PRESENTER	Carroline Lobo has received personal compensation for serving as an employee of EMD Serono.
Barry A. Hendin, MD, FAAN (Phoenix Neurological Associates Ltd)	Dr. Hendin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen, Genentech, Genzyme, Novartis ,EMD Serono,Alexion. Dr. Hendin has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen., Novartis Genentech, Genzyme, EMD Serono, Alexian. Dr. Hendin has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. EMD Serono Genentech Genzyme Novartis Alexian. Dr. Hendin has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Multiple sclerosis association of America. The institution of Dr. Hendin has received research support from Biogen. Genentech.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Amy L. Phillips, PharmD (EMD Serono)	Amy L. Phillips, PharmD has received personal compensation for serving as an employee of EMD Serono, Inc.

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