Long-Term Economic Impact of Nonpersistence to Disease-Modifying Therapies in a Cohort of German Patients With Multiple Sclerosis
Author(s)
Stefan Braune, MD1, Arnfin Bergmann, MD2, Yanic Heer, PhD3, Jana Bianca Jarecki, PhD4, Erwan Muros-Le Rouzic, MPH, MSc5, Diana Sun, PhD6, Siadimas Thanos, MSc7.
1NeuroTransData, Neuburg, Germany, 2NeuroTransData, Neuburg an der Donau, Germany, 3Rewoso AG, Zurich, Switzerland, 4Rewoso - a real-world insights consultancy, Zurich, Switzerland, 5Senior Principle Data Scientist, Roche, Basel, Switzerland, 6Genentech, South San Francisco, CA, USA, 7Roche, Basel, Switzerland.
1NeuroTransData, Neuburg, Germany, 2NeuroTransData, Neuburg an der Donau, Germany, 3Rewoso AG, Zurich, Switzerland, 4Rewoso - a real-world insights consultancy, Zurich, Switzerland, 5Senior Principle Data Scientist, Roche, Basel, Switzerland, 6Genentech, South San Francisco, CA, USA, 7Roche, Basel, Switzerland.
OBJECTIVES: Non-persistence to disease-modifying therapies (DMTs) for multiple sclerosis (MS) may compromise treatment efficacy for controlling disease course. This study investigated the societal costs associated with non-persistence to DMTs by comparing long-term economic outcomes of patients persistent with their DMTs versus those non-persistent.
METHODS: A retrospective cohort study of adult patients with relapsing-remitting MS, initiating a DMT between 2014 and 2017, followed-up through 2023 within the German NeuroTransData MS registry. Inclusion criteria were: ≥6 years of follow-up from first (index) DMT; complete baseline data (age, gender, disability status, and diagnosis date); no disability pension at index. DMTs were grouped by route of administration, mechanism of action, and efficacy based on German MS therapy guidelines. Non-persistence was defined as discontinuation or switching to a different DMT group within 2 years post-index DMT. Marginal structural models, adjusted for baseline and time-varying confounders, were used to evaluate the impact of non-persistence on costs, including direct medical (inpatient care/day admissions, consultations, tests, non-DMT drug costs), non-medical (investments, community services, informal care), indirect (short/long-term absence, early retirement), and total societal costs.
RESULTS: 648 patients were classified as non-persistent and 1,522 as persistent after 2 years of treatment. After 4 years of follow-up, non-persistent patients accumulated significantly higher costs (€7670 more, 60% higher cost ratio [CR], p<.001), direct medical costs (€1088 more, 30% higher CR, p=.03), and indirect costs (€6001 more, 80% higher CR, p=.007). Direct non-medical costs were higher (€580 more, 50% higher CR), but not statistically significant (p=.054). Non-persistent patients had a significantly higher risk of requiring disability pension (hazard ratio [HR]=1.8, 95% CI: 1.2-2.4) and walking aids (HR=2.0, 95% CI: 1.1-3.1).
CONCLUSIONS: Non-persistence to MS DMTs substantially increases future societal costs, mainly through indirect and direct medical expenses. Considering treatment persistence during DMTs decision-making may help reduce the overall economic burden of MS from a societal perspective.
METHODS: A retrospective cohort study of adult patients with relapsing-remitting MS, initiating a DMT between 2014 and 2017, followed-up through 2023 within the German NeuroTransData MS registry. Inclusion criteria were: ≥6 years of follow-up from first (index) DMT; complete baseline data (age, gender, disability status, and diagnosis date); no disability pension at index. DMTs were grouped by route of administration, mechanism of action, and efficacy based on German MS therapy guidelines. Non-persistence was defined as discontinuation or switching to a different DMT group within 2 years post-index DMT. Marginal structural models, adjusted for baseline and time-varying confounders, were used to evaluate the impact of non-persistence on costs, including direct medical (inpatient care/day admissions, consultations, tests, non-DMT drug costs), non-medical (investments, community services, informal care), indirect (short/long-term absence, early retirement), and total societal costs.
RESULTS: 648 patients were classified as non-persistent and 1,522 as persistent after 2 years of treatment. After 4 years of follow-up, non-persistent patients accumulated significantly higher costs (€7670 more, 60% higher cost ratio [CR], p<.001), direct medical costs (€1088 more, 30% higher CR, p=.03), and indirect costs (€6001 more, 80% higher CR, p=.007). Direct non-medical costs were higher (€580 more, 50% higher CR), but not statistically significant (p=.054). Non-persistent patients had a significantly higher risk of requiring disability pension (hazard ratio [HR]=1.8, 95% CI: 1.2-2.4) and walking aids (HR=2.0, 95% CI: 1.1-3.1).
CONCLUSIONS: Non-persistence to MS DMTs substantially increases future societal costs, mainly through indirect and direct medical expenses. Considering treatment persistence during DMTs decision-making may help reduce the overall economic burden of MS from a societal perspective.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE568
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Neurological Disorders, No Additional Disease & Conditions/Specialized Treatment Areas