Skip to main content
Top
Published in: BMC Neurology 1/2015

Open Access 01-12-2015 | Research article

Adherence and cost in multiple sclerosis patients treated with IM IFN beta-1a: impact of the CARE patient management program

Authors: Zaza Katsarava, Birgit Ehlken, Volker Limmroth, Kirsi Taipale, Sarita Noemi Patel, Gabriele Niemczyk, Karin Rehberg-Weber, Colin Wernsdörfer, for the C.A.R.E. Study Group

Published in: BMC Neurology | Issue 1/2015

Login to get access

Abstract

Background

Disease modifying treatments (DMT) for MS such as interferon beta (IFNβ) have been shown to reduce the risk for disease progression. Therefore adherence to treatment is essential for treatment outcome.Here we want to evaluate if participation in a patient management program (PMP) improves adherence to DMT as well as health and cost outcomes associated with MS.

Methods

In this open-label multicentre prospective observational study, German MS patients treated with once weekly intramuscular (IM) IFNβ-1a (Avonex ®), were offered participation in a PMP and followed for up to 12 months. The PMP included injection trainings, support and quarterly visits for up to 12 months after initiation of therapy. Utilisation of health care services was evaluated.
The primary endpoint was to evaluate the direct and indirect cost associated with MS from payer, patient and societal perspective, in patients who participate in the PMP. Secondary endpoint was the clinical outcome in patients who participate in the PMP (differentiated in adherent versus non-adherent patients).

Results

In total 731 patients (mean age: 38.2, 73.7 % female) were enrolled, 640 (88 %) were observed for twelve months. After six months 34 % of patients had participated in the PMP continuously and 21 % temporarily; 39 % had not participated. After twelve months, the proportions of participants were: 37 % continuously and 19 % temporarily; 40 % had not participated.
After 6 months, mean reduction in cost per patient in the participants group (€ 2151) was almost twice as high as the cost reduction amongst non-participants (€ 1131).
After twelve months, the annual relapse rate was reduced by 58 % compared to baseline in both the participant and non-participant groups.

Conclusions

In a real-world-setting, participation in a patient management program was associated with improved medication adherence and lower total MS-related direct and indirect cost over time.
Literature
1.
go back to reference Weinshenker BG, Bass B, Rice GP, Noseworthy J, Carriere W, Baskerville J, et al. The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability. Brain. 1989;112(Pt 1):133–46.CrossRefPubMed Weinshenker BG, Bass B, Rice GP, Noseworthy J, Carriere W, Baskerville J, et al. The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability. Brain. 1989;112(Pt 1):133–46.CrossRefPubMed
2.
go back to reference Jacobs LD, Cookfair DL, Rudick RA, Herndon RM, Richert JR, Salazar AM, et al. ntramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis. The Multiple Sclerosis Collaborative Research Group (MSCRG). Ann Neurol. 1996;39(3):285–94.CrossRefPubMed Jacobs LD, Cookfair DL, Rudick RA, Herndon RM, Richert JR, Salazar AM, et al. ntramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis. The Multiple Sclerosis Collaborative Research Group (MSCRG). Ann Neurol. 1996;39(3):285–94.CrossRefPubMed
3.
go back to reference Kinkel RP, Dontchev M, Kollman C, Skaramagas TT, O’Connor PW, Simon JH. Association between immediate initiation of intramuscular interferon beta-1a at the time of a clinically isolated syndrome and long-term outcomes: a 10-year follow-up of the Controlled High-Risk Avonex Multiple Sclerosis Prevention Study in Ongoing Neurological Surveillance. Arch Neurol. 2012;69(2):183–90.CrossRefPubMed Kinkel RP, Dontchev M, Kollman C, Skaramagas TT, O’Connor PW, Simon JH. Association between immediate initiation of intramuscular interferon beta-1a at the time of a clinically isolated syndrome and long-term outcomes: a 10-year follow-up of the Controlled High-Risk Avonex Multiple Sclerosis Prevention Study in Ongoing Neurological Surveillance. Arch Neurol. 2012;69(2):183–90.CrossRefPubMed
4.
go back to reference Rudick RA, Goodkin DE, Jacobs LD, Cookfair DL, Herndon RM, Richert JR, et al. Impact of interferon beta-1a on neurologic disability in relapsing multiple sclerosis. The Multiple Sclerosis Collaborative Research Group (MSCRG). Neurology. 1997;49(2):358–63.CrossRefPubMed Rudick RA, Goodkin DE, Jacobs LD, Cookfair DL, Herndon RM, Richert JR, et al. Impact of interferon beta-1a on neurologic disability in relapsing multiple sclerosis. The Multiple Sclerosis Collaborative Research Group (MSCRG). Neurology. 1997;49(2):358–63.CrossRefPubMed
5.
go back to reference Johnson KP, Brooks BR, Cohen JA, Ford CC, Goldstein J, Lisak RP, et al. Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of a phase III multicenter, double-blind placebo-controlled trial. The Copolymer 1 Multiple Sclerosis Study Group. Neurology. 1995;45(7):1268–76.CrossRefPubMed Johnson KP, Brooks BR, Cohen JA, Ford CC, Goldstein J, Lisak RP, et al. Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of a phase III multicenter, double-blind placebo-controlled trial. The Copolymer 1 Multiple Sclerosis Study Group. Neurology. 1995;45(7):1268–76.CrossRefPubMed
6.
go back to reference Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. The IFNB Multiple Sclerosis Study Group. Neurology. 1993; 43(4): 655–61. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. The IFNB Multiple Sclerosis Study Group. Neurology. 1993; 43(4): 655–61.
7.
go back to reference Randomised double-blind placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. PRISMS (Prevention of Relapses and Disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis) Study Group. Lancet. 352(9139): 1498–504. Randomised double-blind placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. PRISMS (Prevention of Relapses and Disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis) Study Group. Lancet. 352(9139): 1498–504.
8.
go back to reference Steinberg SC, Faris RJ, Chang CF, Chan A, Tankersley MA. Impact of adherence to interferons in the treatment of multiple sclerosis: a non-experimental, retrospective, cohort study. Clin Drug Invest. 2010;30(2):89–100.CrossRef Steinberg SC, Faris RJ, Chang CF, Chan A, Tankersley MA. Impact of adherence to interferons in the treatment of multiple sclerosis: a non-experimental, retrospective, cohort study. Clin Drug Invest. 2010;30(2):89–100.CrossRef
9.
go back to reference Ivanova JI, Bergman RE, Birnbaum HG, Phillips AL, Stewart M, Meletiche DM. Impact of medication adherence to disease-modifying drugs on severe relapse, and direct and indirect costs among employees with multiple sclerosis in the US. J Med Econ. 2012;15(3):601–9.CrossRefPubMed Ivanova JI, Bergman RE, Birnbaum HG, Phillips AL, Stewart M, Meletiche DM. Impact of medication adherence to disease-modifying drugs on severe relapse, and direct and indirect costs among employees with multiple sclerosis in the US. J Med Econ. 2012;15(3):601–9.CrossRefPubMed
10.
go back to reference Treadaway K, Cutter G, Salter A, Lynch S, Simsarian J, Corboy J, et al. Factors that influence adherence with disease-modifying therapy in MS. J Neurol. 2009;256(4):568–76.CrossRefPubMed Treadaway K, Cutter G, Salter A, Lynch S, Simsarian J, Corboy J, et al. Factors that influence adherence with disease-modifying therapy in MS. J Neurol. 2009;256(4):568–76.CrossRefPubMed
11.
go back to reference Devonshire V, Lapierre Y, Macdonell R, Ramo-Tello C, Patti F, Fontoura P. u. a. The Global Adherence Project (GAP): a multicenter observational study on adherence to disease-modifying therapies in patients with relapsing-remitting multiple sclerosis. Eur J Neurol. 2011;18(1):69–77.CrossRefPubMed Devonshire V, Lapierre Y, Macdonell R, Ramo-Tello C, Patti F, Fontoura P. u. a. The Global Adherence Project (GAP): a multicenter observational study on adherence to disease-modifying therapies in patients with relapsing-remitting multiple sclerosis. Eur J Neurol. 2011;18(1):69–77.CrossRefPubMed
12.
go back to reference Tan H, Cai Q, Agarwal S, Stephenson JJ, Kamat S. Impact of adherence to disease-modifying therapies on clinical and economic outcomes among patients with multiple sclerosis. Adv Ther. 2011;28(1):51–61.CrossRefPubMed Tan H, Cai Q, Agarwal S, Stephenson JJ, Kamat S. Impact of adherence to disease-modifying therapies on clinical and economic outcomes among patients with multiple sclerosis. Adv Ther. 2011;28(1):51–61.CrossRefPubMed
13.
go back to reference Lafata JE, Cerghet M, Dobie E, Schultz L, Tunceli K, Reuther J, et al. Measuring adherence and persistence to disease-modifying agents among patients with relapsing remitting multiple sclerosis. J Am Pharm Assoc. 2008;48(6):752–7.CrossRef Lafata JE, Cerghet M, Dobie E, Schultz L, Tunceli K, Reuther J, et al. Measuring adherence and persistence to disease-modifying agents among patients with relapsing remitting multiple sclerosis. J Am Pharm Assoc. 2008;48(6):752–7.CrossRef
14.
go back to reference Menzin J, Caon C, Nichols C, White LA, Friedman M, Pill MW. Narrative review of the literature on adherence to disease-modifying therapies among patients with multiple sclerosis. J Manag Care Pharm. 2013;19(1 Suppl A):S24–40.PubMed Menzin J, Caon C, Nichols C, White LA, Friedman M, Pill MW. Narrative review of the literature on adherence to disease-modifying therapies among patients with multiple sclerosis. J Manag Care Pharm. 2013;19(1 Suppl A):S24–40.PubMed
15.
go back to reference Tremlett HL, Oger J. Interrupted therapy: stopping and switching of the beta-interferons prescribed for MS. Neurology. 2003;61(4):551–4.CrossRefPubMed Tremlett HL, Oger J. Interrupted therapy: stopping and switching of the beta-interferons prescribed for MS. Neurology. 2003;61(4):551–4.CrossRefPubMed
16.
go back to reference Río J, Porcel J, Téllez N, Sánchez-Betancourt A, Tintoré M, Arévalo MJ, et al. Factors related with treatment adherence to interferon beta and glatiramer acetate therapy in multiple sclerosis. Mult Scler. 2005;11(3):306–9.CrossRefPubMed Río J, Porcel J, Téllez N, Sánchez-Betancourt A, Tintoré M, Arévalo MJ, et al. Factors related with treatment adherence to interferon beta and glatiramer acetate therapy in multiple sclerosis. Mult Scler. 2005;11(3):306–9.CrossRefPubMed
17.
go back to reference Brandes DW, Callender T, Lathi E, O’Leary S. A review of disease-modifying therapies for MS: maximizing adherence and minimizing adverse events. Curr Med Res Opin. 2009;25(1):77–92.CrossRefPubMed Brandes DW, Callender T, Lathi E, O’Leary S. A review of disease-modifying therapies for MS: maximizing adherence and minimizing adverse events. Curr Med Res Opin. 2009;25(1):77–92.CrossRefPubMed
18.
go back to reference Caon C, Saunders C, Smrtka J, Baxter N, Shoemaker J. Injectable disease-modifying therapy for relapsing-remitting multiple sclerosis: a review of adherence data. J Neurosci Nurs. 2010;42(5 Suppl):S5–9.CrossRefPubMed Caon C, Saunders C, Smrtka J, Baxter N, Shoemaker J. Injectable disease-modifying therapy for relapsing-remitting multiple sclerosis: a review of adherence data. J Neurosci Nurs. 2010;42(5 Suppl):S5–9.CrossRefPubMed
19.
go back to reference Kobelt G, Berg J, Lindgren P, Elias WG, Flachenecker P, Freidel M, et al. Costs and quality of life of multiple sclerosis in Germany. Eur J Health Econ. 2006;7 Suppl 2:S34–44.CrossRefPubMed Kobelt G, Berg J, Lindgren P, Elias WG, Flachenecker P, Freidel M, et al. Costs and quality of life of multiple sclerosis in Germany. Eur J Health Econ. 2006;7 Suppl 2:S34–44.CrossRefPubMed
20.
go back to reference Ofman JJ, Badamgarav E, Henning JM, Knight K, Gano Jr AD, Levan RK, et al. Does disease management improve clinical and economic outcomes in patients with chronic diseases? A systematic review. Am J Med. 2004;117(3):182–92.CrossRefPubMed Ofman JJ, Badamgarav E, Henning JM, Knight K, Gano Jr AD, Levan RK, et al. Does disease management improve clinical and economic outcomes in patients with chronic diseases? A systematic review. Am J Med. 2004;117(3):182–92.CrossRefPubMed
21.
go back to reference Smrtka J, Caon C, Saunders C, Becker BL, Baxter N. Enhancing adherence through education. J Neurosci Nurs. 2010;42(5 Suppl):S19–29.CrossRefPubMed Smrtka J, Caon C, Saunders C, Becker BL, Baxter N. Enhancing adherence through education. J Neurosci Nurs. 2010;42(5 Suppl):S19–29.CrossRefPubMed
23.
go back to reference McHutchison JG, Manns M, Patel K, Poynard T, Lindsay KL, Trepo C, et al. Adherence to combination therapy enhances sustained response in genotype-1-infected patients with chronic hepatitis C. Gastroenterology. 2002;123(4):1061–9.CrossRefPubMed McHutchison JG, Manns M, Patel K, Poynard T, Lindsay KL, Trepo C, et al. Adherence to combination therapy enhances sustained response in genotype-1-infected patients with chronic hepatitis C. Gastroenterology. 2002;123(4):1061–9.CrossRefPubMed
24.
go back to reference Graf von der Schulenburg J-M, Greiner W, Jost F, Klusen N, Kubin M, Leidl R, et al. German recommendations on health economic evaluation: third and updated version of the Hanover Consensus. Value Health. 2008;11(4):539–44.CrossRefPubMed Graf von der Schulenburg J-M, Greiner W, Jost F, Klusen N, Kubin M, Leidl R, et al. German recommendations on health economic evaluation: third and updated version of the Hanover Consensus. Value Health. 2008;11(4):539–44.CrossRefPubMed
31.
go back to reference Tan H, Yu J, Tabby D, Devries A, Singer J. Clinical and economic impact of a specialty care management program among patients with multiple sclerosis: a cohort study. Mult Scler. 2010;16(8):956–63.CrossRefPubMedPubMedCentral Tan H, Yu J, Tabby D, Devries A, Singer J. Clinical and economic impact of a specialty care management program among patients with multiple sclerosis: a cohort study. Mult Scler. 2010;16(8):956–63.CrossRefPubMedPubMedCentral
32.
go back to reference Halpern R, Agarwal S, Dembek C, Borton L, Lopez-Bresnahan M. Comparison of adherence and persistence among multiple sclerosis patients treated with disease-modifying therapies: a retrospective administrative claims analysis. Patient Prefer Adherence. 2011;5:73–84.CrossRefPubMedPubMedCentral Halpern R, Agarwal S, Dembek C, Borton L, Lopez-Bresnahan M. Comparison of adherence and persistence among multiple sclerosis patients treated with disease-modifying therapies: a retrospective administrative claims analysis. Patient Prefer Adherence. 2011;5:73–84.CrossRefPubMedPubMedCentral
33.
go back to reference Kleinman NL, Beren IA, Rajagopalan K, Brook RA. Medication adherence with disease modifying treatments for multiple sclerosis among US employees. J Med Econ. 2010;13(4):633–40.CrossRefPubMed Kleinman NL, Beren IA, Rajagopalan K, Brook RA. Medication adherence with disease modifying treatments for multiple sclerosis among US employees. J Med Econ. 2010;13(4):633–40.CrossRefPubMed
34.
go back to reference Riñon A, Buch M, Holley D, Verdun E. The MS Choices Survey: findings of a study assessing physician and patient perspectives on living with and managing multiple sclerosis. Patient Prefer Adherence. 2011;5:629–43.PubMedPubMedCentral Riñon A, Buch M, Holley D, Verdun E. The MS Choices Survey: findings of a study assessing physician and patient perspectives on living with and managing multiple sclerosis. Patient Prefer Adherence. 2011;5:629–43.PubMedPubMedCentral
35.
go back to reference Phillips JT, Fox E, Grainger W, Tuccillo D, Liu S, Deykin A. An open-label, multicenter study to evaluate the safe and effective use of the single-use autoinjector with an Avonex® prefilled syringe in multiple sclerosis subjects. BMC Neurol. 2011;11:126.CrossRefPubMedPubMedCentral Phillips JT, Fox E, Grainger W, Tuccillo D, Liu S, Deykin A. An open-label, multicenter study to evaluate the safe and effective use of the single-use autoinjector with an Avonex® prefilled syringe in multiple sclerosis subjects. BMC Neurol. 2011;11:126.CrossRefPubMedPubMedCentral
Metadata
Title
Adherence and cost in multiple sclerosis patients treated with IM IFN beta-1a: impact of the CARE patient management program
Authors
Zaza Katsarava
Birgit Ehlken
Volker Limmroth
Kirsi Taipale
Sarita Noemi Patel
Gabriele Niemczyk
Karin Rehberg-Weber
Colin Wernsdörfer
for the C.A.R.E. Study Group
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2015
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-015-0426-x

Other articles of this Issue 1/2015

BMC Neurology 1/2015 Go to the issue