TRENDS IN OUT-OF-POCKET AND TOTAL HEALTHCARE COSTS AMONG COMMERCIALLY-INSURED PATIENTS WITH MULTIPLE SCLEROSIS IN THE US, 2002-2021
Author(s)
Mackenzie Henderson, Pharm.D., M.S.1, Daniel Horton, M.D., M.S.C.E.2, Vikram Bhise, M.D.2, Greta Bushnell, Ph.D.1, Chintan Dave, Pharm.D., Ph.D.3;
1Rutgers Center for Pharmacoepidemiology and Treatment Science, New Brunswick, NJ, USA, 2Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA, 3Rutgers University, New Brunswick, NJ, USA
1Rutgers Center for Pharmacoepidemiology and Treatment Science, New Brunswick, NJ, USA, 2Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA, 3Rutgers University, New Brunswick, NJ, USA
OBJECTIVES: Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that has no known cure. Newer disease-modifying therapies (DMTs) have been shown to slow the progression of MS, but their use in everyday practice is influenced by financial constraints. This study aimed to evaluate trends in annual out-of-pocket and overall healthcare costs among commercially-insured children and adults with MS under 65 years old in the US.
METHODS: We conducted a serial cross-sectional study using MarketScan commercial claims data from 2002-2021. Patients diagnosed with MS continuously enrolled in medical/pharmacy coverage throughout the calendar year were included and followed across successive qualifying years. We evaluated inflation-adjusted healthcare costs, categorized as DMT-related costs or other costs (outpatient, hospitalization, or prescription), calculating both out-of-pocket and total healthcare costs. Costs were evaluated by calendar year, and we assessed for presence of secular trends using linear regression.
RESULTS: Overall, 597,040 observations were identified from 199,857 unique patients. The average age was 48 years, and 76.8% were female. Annual inflation-adjusted out-of-pocket costs increased by 125% throughout the study period, from $1,783 in 2002 to $4,016 in 2021 (p<0.001 for trend). DMT-related out-of-pocket costs accounted for a large portion of this, increasing by 818%, from $228 in 2002 to $2,093 in 2021 (p<0.001 for trend). Total healthcare costs followed a similar trend, increasing from $23,770 in 2002 to $73,562 in 2021 (p<0.001 for trend). DMT-related costs accounted for 86.7% of this increase, rising to $52,059 (2021) and accounting for 71% of total healthcare costs in 2021.
CONCLUSIONS: Among US patients <65 years old with MS, annual inflation-adjusted out-of-pocket and total healthcare costs increased markedly throughout the study period, driven primarily by rising DMT-related costs. Our findings contribute to an improved understanding of how the cost of MS management has evolved with the availability of newer, more effective treatments.
METHODS: We conducted a serial cross-sectional study using MarketScan commercial claims data from 2002-2021. Patients diagnosed with MS continuously enrolled in medical/pharmacy coverage throughout the calendar year were included and followed across successive qualifying years. We evaluated inflation-adjusted healthcare costs, categorized as DMT-related costs or other costs (outpatient, hospitalization, or prescription), calculating both out-of-pocket and total healthcare costs. Costs were evaluated by calendar year, and we assessed for presence of secular trends using linear regression.
RESULTS: Overall, 597,040 observations were identified from 199,857 unique patients. The average age was 48 years, and 76.8% were female. Annual inflation-adjusted out-of-pocket costs increased by 125% throughout the study period, from $1,783 in 2002 to $4,016 in 2021 (p<0.001 for trend). DMT-related out-of-pocket costs accounted for a large portion of this, increasing by 818%, from $228 in 2002 to $2,093 in 2021 (p<0.001 for trend). Total healthcare costs followed a similar trend, increasing from $23,770 in 2002 to $73,562 in 2021 (p<0.001 for trend). DMT-related costs accounted for 86.7% of this increase, rising to $52,059 (2021) and accounting for 71% of total healthcare costs in 2021.
CONCLUSIONS: Among US patients <65 years old with MS, annual inflation-adjusted out-of-pocket and total healthcare costs increased markedly throughout the study period, driven primarily by rising DMT-related costs. Our findings contribute to an improved understanding of how the cost of MS management has evolved with the availability of newer, more effective treatments.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE351
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Neurological Disorders