Abstract Details

Title Implementation of a Risk-Stratified Multiple Sclerosis Treatment Algorithm: Improved Quality and Affordability

Topic Practice, Policy, and Ethics

Presentation(s) S22 - Practice, Policy, and Ethics: Improving Patient Care and the Rise of Telemedicine (4:54 PM-5:06 PM)

Poster/Presentation
Number 008

Objective To implement the KP risk-stratified MS treatment algorithm in Kaiser Permanente Southern California (KPSC) and determine whether it improves quality and affordability of MS care.

Background We designed a risk-stratified, cost-sensitive multiple sclerosis (MS) treatment algorithm to achieve increased use of highly effective disease-modifying treatments (DMTs; HETs) and a rational approach to prescribing modestly effective DMTs (meDMTs).

Design/Methods Physician-expert led implementation of the KP algorithm began in 2013, in partnership with Pharmacy, Health Plan and KPSC Practice Group Leaders. KPSC provides comprehensive healthcare to over 4 million people. Implementation was achieved through a coordinated approach with regular meetings, audit and feedback and hiring of MS and pharmacy specialists. Solumedrol infusions and hospitalizations for MS to estimate clinically significant relapses and DMT use were obtained from the complete electronic health record.

Results The proportion of DMT-treated MS patients on HET increased from 9% (2012 pre-implementation) to 65.5% in 2018. Ever DMT-treated MS patients increased from 3539 to 4423 members, yet the total and per-patient-per-year MS DMT expenditure dropped from $68.4M and $68K in 2012 to $47.15M and $30.3K in 2018. The average cost of the preferred interferon-beta and glatiramer acetate product dropped from $31.1K/person/year in 2012 to $17.6K in 2018. During the same timeframe, outpatient episodes of solumedrol infusions and inpatient admissions for MS declined steadily from a combined incidence rate of 174 (95%CI=161-187) in 2012 to 73 (95%CI=64-81) per 1000-patient-years in 2018.

Conclusions Our results demonstrate that MS DMT expenditures can be significantly reduced even with ever-escalating wholesale prices without sacrificing quality. Through coordinated efforts led by clinicians to design and implement our risk-stratified treatment algorithm, utilizations of HETs increased, clinically significant MS relapses decreased by 58%, and MS DMT expenditures decreased by $21.25M annually. Reduced expenditures were accomplished by increased prescribing of rituximab and by creating competition among interferon-beta and glatiramer acetate manufacturers.

Authors/Disclosures
Annette M. Langer-Gould, MD, PhD (Kaiser Permanente Southern California) PRESENTER	An immediate family member of Dr. Langer-Gould has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Annals of American Thoracic Society. The institution of Dr. Langer-Gould has received research support from PCORI. The institution of an immediate family member of Dr. Langer-Gould has received research support from PCORI, ARQ, NIH. Dr. Langer-Gould has a non-compensated relationship as a Voting Member with ICER CTAF Panel that is relevant to AAN interests or activities.
Stephen W. Cheng, MD	No disclosure on file
Jessica B. Smith, MPH (Kaiser Permanente)	Ms. Smith has nothing to disclose.
Bonnie Li	Bonnie Li has received personal compensation for serving as an employee of Kaiser Permanente.
	No disclosure on file

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