Cost of managing an episode of relapse in multiple sclerosis in the United States

Judith A O'Brien, Alexandra J Ward, Amanda R Patrick, Jaime Caro, Judith A O'Brien, Alexandra J Ward, Amanda R Patrick, Jaime Caro

Abstract

Background: The purpose of this study was to determine the direct medical US cost of managing multiple sclerosis relapses.

Methods: Direct data analysis and cost modeling were employed to derive typical resource use profiles and costs in 2002 US dollars, from the perspective of a third-party payer responsible for comprehensive health-care. The location and scope of health care services provided over a 90-day period were used to define three levels of relapse management. Hospitalization and resulting subsequent care was defined as high intensity management. A medium level of intervention was defined as either use of the emergency room, an observational unit, or administration of acute treatments, such as intravenous methylprednisolone in an outpatient or home setting. The lowest intensity of care comprised physician office visits and symptom-related medications. Data were obtained from many sources including all payer inpatient, ambulatory and emergency room databases from several states, fee schedules, government reports, and literature. All charges were adjusted using cost-to-charge ratios.

Results: Average cost per person for high management level was 12,870 dollars, based on analysis of 4,634 hospital cases (mean age 48 years, 73% female). Hospital care comprised 71% of that cost. At discharge, 36% required inpatient sub-acute care, rehabilitation or home care. The typical cost per moderate episode was 1,847 dollars and mild episode 243 dollars.

Conclusions: Management strategies leading to a reduction in the frequency and severity of a relapse, less reliance on inpatient care, or increased access to steroid infusions in the home, would have a substantial impact on the economic consequences of managing relapses.

Figures

Figure 1
Figure 1
Overview of health care services and resource use profiles used to define management levels during a 90-day relapse episode
Figure 2
Figure 2
Distribution of multiple sclerosis cases from state databases by primary payer
Figure 3
Figure 3
Proportion of overall high-level management cost by major cost components
Figure 4
Figure 4
Proportion of overall medium level management cost by major cost components

References

    1. National Institute of Neurological Disorders and Stroke. Multiple Sclerosis: Hope Through Research. NIH. 2002.
    1. Runmarker B, Andersen O. Prognostic factors in a multiple sclerosis incidence cohort with twenty-five years of follow-up. Brain. 1993;116:117–164.
    1. Weinshenker BG, Bass B, Rice GP, Noseworthy J, Carriere W, Baskerville J, Ebers GC. The natural history of multiple sclerosis: a geographically based study. 2. Predictive value of the early clinical course. Brain. 1989;112:1419–1428.
    1. Whetten-Goldstein K, Sloan FA, Goldstein LB, Kulas ED. A comprehensive assessment of the cost of multiple sclerosis in the United States. Multiple Sclerosis. 1998;4:419–425. doi: 10.1191/135245898678919401.
    1. Lacy JR, Stuart WH, Jacobs LD, Vartanian T, Phillips JT, Greenstein JI. Registry of Multiple Sclerosis Treatment and Care (MSTRAC) Patient and Physician Characteristics. Int J MS Care. 2000;2
    1. Hauser SL, Goodkin DE. Harrison's Principles of Medicine. 15. McGraw-Hill Companies Inc.; 2001. Multiple sclerosis and other demyelinating diseases; pp. 2452–2461.
    1. Scott TF, Schramke CJ, Novero J, Chieffe C. Short-term prognosis in early relapsing-remitting multiple sclerosis. Neurology. 2000;55:689–693.
    1. California 1999 Discharge Data (Version A) Office of Statewide Health Planning and Development.
    1. Florida 1999 Hospital Patient Data File. State of Florida, Agency for Health Care Administration, State Center for Health Statistics.
    1. Massachusetts Fiscal Year 1999 Acute Hospital Case Mix Data Base, Level III. Massachusetts Division of Health Care Finance and Policy.
    1. Maryland 1999 Inpatient Public Use File. St Paul Computer Center, Inc.
    1. Washington 1999 CHARS (Comprehensive Hospital Abstract Reporting System) Public Data File. Washington State Department of Health, Office of Hospital and Patient Data.
    1. Annual Physician Fee Schedule Payment Amount File. Health Care Financing Agency. 2002. Accessed November 2001.
    1. Veririlli DK, Zuckerman S. Health Care Financing Review Spring. 1996. pp. 161–170.
    1. 2001 Florida Medicaid physician fee schedule
    1. Foundation for Healthy Communities. Specialty Hospital Standard Reports, 1999 New Hampshire Hospital Association. 2001.
    1. Foundation for Healthy Communities. Specialty Hospital Standard Reports, 1998 New Hampshire Hospital Association. 2000.
    1. Foundation for Healthy Communities. Specialty Hospital Standard Reports, 1997 New Hampshire Hospital Association. 1999.
    1. Foundation for Healthy Communities. Specialty Hospital Standard Reports, 1996 New Hampshire Hospital Association. 1998.
    1. Medicare and Medicaid Statistical Supplement, 2000. Health Care Finance Review US Dept of Health and Human Services HCFA Office of Strategic Planning, Baltimore. 2001.
    1. Minnesota Case Mix Research Database. Quality Assurance and Review Program, Minnesota Department of Health. 1998.
    1. The Guide to the Nursing Home Industry, 2001. HCIASachs, LLC, Baltimore, MD and Arthur Andersen, LLP, Hartford, CT. 2000.
    1. Manton KG, Cornelius ES, Woodbury MA. Nursing home residents: a multivariate analysis of their medical, behavioral, psychosocial, and service use characteristics. J Gerontol A Biol Sci Med Sci. 1995;50:M242–M251.
    1. Utah Emergency Department Encounter Database, 1999 Public-Use Data File. Bureau of Emergency Medical Services, Utah Department of Health.
    1. Massachusetts Outpatient Observation Case Mix and Charge Data, Fiscal Year1999. Massachusetts Division of Health Care Finance and Policy.
    1. Florida Medicaid Outpatient Database, 1999. Medicaid Program Analysis, State of Florida, Agency for Health Care Administration.
    1. National Ambulatory Medical Care Survey. National Center for Health Statistics, Washington, DC. 1997.
    1. National Ambulatory Medical Care Survey. National Center for Health Statistics, Washington, DC. 1998.
    1. National Ambulatory Medical Care Survey. National Center for Health Statistics, Washington, DC. 1999.
    1. Parkin D, McNamee P, Jacoby A, Miller P, Thomas S, Bates D. A cost-utility analysis of interferon beta for multiple sclerosis. Health Technology Assessment. 1998;2:27–29.
    1. Tremlett HL, Luscombe DK, Wiles CM. Use of corticosteroids in multiple sclerosis by consultant neurologists in the United Kingdom. J Neurol Neurosurg Psychiatry. 1998;65:362–365.
    1. Vickrey BG, Shatin D, Wolf SM, Myers LW, Belin TR, Hanson RA, Shapiro MF, Beckstrand M, Edmonds ZV, Delrahim S, Ellison GW. Management of Multiple Sclerosis across managed care and fee-for-service systems. Neurology. 2000;55:1341–1349.
    1. Rudick RA, Cohen JA, Weinstock-Guttman B, Kinkel RP, Ransohoff Management of Multiple Sclerosis. N Engl J Med. 1997;337:1604–1611. doi: 10.1056/NEJM199711273372207.
    1. The APG Handbook. HCIA Inc, Baltimore, MD and 3M Health Care, Wallingford, CT. 1997.
    1. National Ambulatory Medical Care Survey. National Center for Health Statistics, Washington, DC. 1998.
    1. 1999 National Ambulatory Medical Care Survey Data File Documentation. National Center for Health Statistics, Washington, DC.
    1. Minden SL, Marder WD, Harrold LN, Dor A. Multiple Sclerosis, A Statistical Portrait. A Compendium of Data, Demographics, Disability and Health Services Utilization in the United States Prepared for the National Multiple Sclerosis Society by AbtAssociates, Inc. 1993.
    1. American Medical Association: Physicians' Current Procedural Terminology. Chicago, American Medical Association. 2001.
    1. Grima DT, Torrance GW, Francis G, Rice G, Rosner AJ, Lafortune L. Cost and health quality of life consequences of multiple sclerosis. Multiple Sclerosis. 2000;6:91–98. doi: 10.1191/135245800678827545.
    1. 2001 Drug Topics Red Book. Montvale, NJ, Medical Economics. 1999.
    1. Beck RW, Cleary PA, Anderson MK, Keltner JL, Shults WT, Kaufman DI, Buckley EG, Corbett JJ, Kupersmith MJ, Miller NR, Savino PJ, Guy JR, Trobe JD, McCrary JA, Smith CH, Brodsky MC, Goodwin JA, Atwell CW, the Optic Neuritis Study Group A Randomized, Clinical Trial of Corticosteroids in the Treatment of Acute Optic Neuritis. N Engl J Med. 1992;326:581–588.
    1. Wen LK, Lawson KA, Khan ZM. A Survey of Operational Costs Incurred by Home Infusion Pharmacies. Infusion. 1997. pp. 44–51.
    1. Bureau of Labor Statistics. 1997.
    1. Weinshenker BG, Bass B, Rice GP, Noseworthy J, Carriere W, Baskerville J, Ebers GC. The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability. Brain. 1989;112:133–146.
    1. Confavreux C, Vukusic S, Moreau T, Adeleine P. Relapses and Progression in Multiple Sclerosis. N Engl J Med. 2000;343:1430–1438. doi: 10.1056/NEJM200011163432001.
    1. Burks J. Multiple Sclerosis Care: An Integrated Disease-Management Model. J of Spinal Cord Medicine. 1998;21:113–116.
    1. Coverage Policy Bulletins No. 0264: Multiple Sclerosis Treatments. Aetna Insurance Company.
    1. Bourdette DN, Prochazka AV, Mitchell W, Licari P, Burks J. Health Care Costs of Veterans with Multiple Sclerosis: Implications for the Rehabilitation of MS. Arch Phys Med Rehabil. 1993;74:26–31.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj