Abstract Details

Title Medical Care Costs of Patients with Amyotrophic Lateral Sclerosis in the Medicare Program

Topic Anterior Horn

Presentation(s) P07 - (-)

Poster/Presentation
Number 065

Objective

Background BACKGROUND: Since 2003, ALS patients have been granted immediate Federal disability insurance and Medicare.

Design/Methods DESIGN/METHODS: From a 20% Medicare sample (2002-2008), two cohorts, ?65 (N=2,605) and <65 (N=1,513), with ?2 ALS diagnoses (ICD-9-CM 335.20) spanning ?90 days, were followed from initial diagnosis until death or end of 2008. Kaplan-Meier Sampling Average (KMSA) methods were used to estimate population-level lifetime medical costs (2011 USD), excluding drugs and out-of-pocket expenses. KMSA costs reflect average per-patient net present value of future lifetime costs from diagnosis. Regression analyses were used to estimate monthly and incremental costs associated with use of tracheostomy, gastrostomy and noninvasive positive pressure ventilation (NPPV) and to model effects on monthly costs of delaying time to each LSI.

Results RESULTS: Median survival was 17.5m (age ?65) and 29m (<65). In the ?65 cohort, 27% of patients used NPPV, 9% tracheostomy, and 32% gastrostomy (<65: 36%, 14%, 35%, respectively). Mean lifetime costs were $76,095 (?65) and $96,561 (<65) with average per-patient monthly costs of $3,066 (?65) and $3,106 (<65). Lifetime costs were significantly higher in patients using LSIs, e.g. with/without tracheostomy (?65: $219,101 vs $61,302; <65: $171,187 vs $92,401). Mean monthly costs for patients with tracheostomy (?65: $7,100; <65: $6,500) and gastrostomy (?65: $3,600; <65: $4,000) were high but declined with increasing time to LSI, e.g. tracheostomy at 8m vs 18m (?65: $6,817 vs $4,492; <65: $6,263 vs $4,328).

Conclusions CONCLUSIONS: ALS is associated with substantial lifetime medical costs. Our lifetime cost estimate in ?65 ALS patients was >3 times the average Medicare beneficiary's costs ($18,000). Delaying time to LSI was associated with monthly cost reductions of $332-$2,225 (10-50%). Therapies that slow functional decline could significantly lower monthly Medicare costs while potentially improving quality of life.

Authors/Disclosures
PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
Derrick Robertson, MD	Dr. Robertson has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. Dr. Robertson has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Robertson has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Robertson has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD Serono. Dr. Robertson has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Robertson has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Greenwich Biosciences. Dr. Robertson has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Horizon. Dr. Robertson has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Janssen. Dr. Robertson has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Robertson has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi Genzyme. Dr. Robertson has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for TG Therapeutics. Dr. Robertson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mallinckrodt. Dr. Robertson has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion. Dr. Robertson has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Biogen. Dr. Robertson has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Bristol Myers Squibb. Dr. Robertson has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for EMD Serono. Dr. Robertson has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Genentech. Dr. Robertson has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sanofi Genzyme. Dr. Robertson has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for PRIME CME. Dr. Robertson has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Janssen. Dr. Robertson has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Horizon. Dr. Robertson has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for TG Therapeutics. Dr. Robertson has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for McVeigh. Dr. Robertson has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Mccumber. Dr. Robertson has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Goodis. The institution of Dr. Robertson has received research support from Biogen. The institution of Dr. Robertson has received research support from EMD Serono. The institution of Dr. Robertson has received research support from Jansenn. The institution of Dr. Robertson has received research support from Genentech. The institution of Dr. Robertson has received research support from Patient-Centered Outcomes Research Institute. The institution of Dr. Robertson has received research support from Novartis. The institution of Dr. Robertson has received research support from Sanofi Genzyme. The institution of Dr. Robertson has received research support from TG Therapeutics. The institution of Dr. Robertson has received research support from Prime. The institution of Dr. Robertson has received research support from Greenwich Biosciences. The institution of Dr. Robertson has received research support from Atara Biotherapeutics. The institution of Dr. Robertson has received research support from CorEvitas. The institution of Dr. Robertson has received research support from Anokion. The institution of Dr. Robertson has received research support from UCB Biosciences. Dr. Robertson has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Consortium of Multiple Sclerosis Centers. Dr. Robertson has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Multiple Sclerosis Association of America.
Leigh Ann White (Biogen Idec)	No disclosure on file

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