Multiple Sclerosis Treatment Adherence Correlates with Higher Care Costs

Jove Graham, PhD

Medication adherence for multiple sclerosis (MS) patients appears to bring about both higher health costs and better MS outcomes, according to a new report.

Researchers from the Geisinger Health System in Danville, Pennsylvania retrospectively studied the medical records and insurance claims of 681 patients with MS in order to understand the adherence of MS patients within large integrated health systems. They also sought to explore the relationship between adherence and outcomes.

Adherence and outcomes are more difficult to measure in MS patients than with diseases such as hypertention, where medications are taken orally and surrogate outcomes are routinely collected, researchers noted. Regardless, they obtained the health records from 2004 to 2013 and also read prospective surveys which asked about regarding adherence and functional outcomes from 2012 and 2013.

A majority of the patients were either discovered to have or reported greater than 80% adherence to their medications.

“Overall, adherence to the MS medications was much higher than we’ve typically seen in studies of diabetes or hypertension medications,” author Jove Graham, PhD, told MD Magazine. “That’s good news for those patients and doctors, though it makes our job as researchers more difficult if we are trying to measure the impact of low versus high adherence and most patients are high adherers!”

The researchers also observed that mean inpatient days for MS-related admissions were the highest for patients categorized as high adherence rather than intermediate or low adherence patients. But no other links between adherence or health care utilization were found.

The impact of having MS was 14% less severe, and the psychological impact was 17% less severe in patients with highest adherence compared to low adherence patients. The researchers found the high adherence patients rated their level of disability 12% lower than other patients, believing their treatments to be as much as 7% more effective.

“We did expect that patients with the highest adherence would have the lowest healthcare costs (because they would be less likely to need emergency room care, or hospital visits, or other high-cost care) but that did not turn out to be the case, or at least our study was not large enough to show that was the case,” Graham said. “We were encouraged to see, however, that the patients who were most adherent to their MS medications reported better physical function and satisfaction with their treatment.”

The patients who reported intermediate and high adherence demonstrated better MS outcomes via the Kurtzke Expanded Disability Status Scale, Multiple Sclerosis Impact Scale physical function, and the Treatment Satisfaction Questionnaire for Medication scale.

“We think doctors should be aware that average adherence to MS medications is high but it is still important to discuss with patients because our paper gives further evidence that patients who take their medication have fewer symptoms and better function, even if it may not necessarily have a global impact from an economic or utilization standpoint,” Graham said.

The paper, “Measuring Adherence and Outcomes in the Treatment of Patients With Multiple Sclerosis,” was published online in the Journal of the American Osteopathic Association.