Adherence to Disease-Modifying Therapies in Pregnant MS Patients Can Reduce Hospitalization

Results from research analyzing data of females with multiple sclerosis (MS) who became pregnant, and the impact of adherence to their disease-modifying therapies (DMTs) on hospital utilization and cost, were recently released by AllianceRx Walgreens Prime.

The background of the study, which was conducted by Walgreens and AllianceRx Walgreens Prime, reflects how researchers wanted to understand how non-adherence to DMTs would impact healthcare cost and utilization over a two-year period. What was found was that women continuing their therapy throughout pregnancy had lower hospitalization costs and use compared to those who discontinued their therapy.

MS is a long-term, or chronic, condition affecting the central nervous system. An estimated 2.3 million people worldwide have MS. Women are affected two to three times as often as men, the study said. According to the National MS Society, none of the DMTs are approved for use during pregnancy, yet discontinuing DMTs may cause relapse of disease. Although, for certain DMTs, studies do indicate some patients continue their DMT if advised by their healthcare provider.

“When it comes to pregnancy or thinking of becoming pregnant, a key discussion on the risks and benefits of DMT therapy must take place between the patient and provider," says Kathleen Love, RN, clinical program manager at AllianceRx Walgreens Prime, and an author of the study, when addressing pregnancy among MS patients, which make up a significant patient population.

In a previous study, it was stated that adherence among MS patients to DMT medications can reduce both hospitalization events and related costs by use of measurement methods approved by the Pharmacy Quality Alliance, says Francis Staskon, PhD, senior analyst, health analytics, research and reporting at Walgreens, and lead author of both studies.

Heather Kirkham, PhD, MPH, director, health analytics, research and reporting at Walgreens, and a study author, says the broader study looked at all MS patients not just pregnant MS patients.

“We examined the experience of MS patients not specific to pregnancy and their healthcare utilization and total healthcare cost," Kirkham said. "We decided to look at this subset of patients because they might have a different experience. In the broader study, we did see a relationship between patients who are more adherent having a lower total healthcare cost.”

Using Market Scan commercial claims data over a three-year period (2014-2017), researchers identified MS-diagnosed females and followed their pattern of treatment from outpatient and inpatient visits, as well as DMT pharmaceutical therapy, over two consecutive years.

Researchers created cohorts for those who received pregnancy services in the first year or second year of follow-up, according to their DMT utilization. Using a DMT medication adherence metric, researchers identified patients as adherent to DMT in just one of the years or for both years.

“This was a retrospective observational study, with levels of patient DMT adherence segmented into number of years adherent or not, with outcomes on total adjusted medical costs (inpatient or outpatient non-maternity services), DMT costs and associated MS medication costs,” says Staskon.

According to the research, of the females who utilized maternity services, 82.7% were in the first-year follow-up period. Of the 500 first-year pregnancies, 79% discontinued DMT utilization into their second year. Analysis on 603 patients DMT utilization found 9.2% adherent in both years, 39.9% adherent in one year and 53.9% of patients were non-adherent in both years. Comorbidities were present among 48 patients. Patients who were consistently adherent had significantly lower adjusted 2 medical costs compared to consistently non-adherent patients (-$4,383, p<.002) or to those with mixed adherence (-$2.951, p<.04).

According to Staskon, the study concluded that pregnant MS patients typically reduce their DMT medication adherence, but a significant number continue, and even demonstrate good adherence levels (PDC ≥.80). Average non-maternity medical costs for adherent patients was significantly lower compared to other two DMT non-adherent or discontinued patient groups.

“MS is so unpredictable and unique per individual," says Love. "There are so many choices now for patients with MS, and a very key component in therapy along the continuum of their life is their discussion about their DMT with their prescriber.”