Table 4.
Clinical outcomes and healthcare resource utilization during the follow-up period (Medicare vs. commercial plan type)
| Matched MS patientsa—commercial | Matched MS patientsa—Medicare | |||||
|---|---|---|---|---|---|---|
| Approved patients | Denied patients | Difference | Approved patients | Denied patients | Difference | |
| [A] | [B] | [A] − [B] | [A] | [B] | [A] − [B] | |
| (n = 80) | (n = 87) | (n = 57) | (n = 54) | |||
| Condition-specific characteristics and HCRU | ||||||
| MS exacerbation episode | ||||||
| ≥ 1 exacerbation episode | 21 (26.3%) | 35 (40.2%) | −14.0% | 20 (35.1%) | 20 (37.0%) | −1.9% |
| Patients with 1 exacerbation episode | 18 (22.5%) | 29 (33.3%) | −10.8% | 10 (17.5%) | 14 (25.9%) | −8.4% |
| Patients with 2 exacerbation episodes | 0 (0.0%) | 3 (3.4%) | −3.4% | 5 (8.8%) | 4 (7.4%) | 1.4% |
| Patients with ≥ 3 exacerbation episodes | 3 (3.8%) | 3 (3.4%) | 0.3% | 5 (8.8%) | 2 (3.7%) | 5.1% |
| Neurologic impairment indicators | ||||||
| Pain | 15 (18.8%) | 23 (26.4%) | −7.7% | 21 (36.8%) | 22 (40.7%) | −3.9% |
| Fatigue | 30 (37.5%) | 31 (35.6%) | 1.9% | 13 (22.8%) | 14 (25.9%) | −3.1% |
| Depression | 40 (50.0%) | 38 (43.7%) | 6.3% | 30 (52.6%) | 33 (61.1%) | −8.5% |
| Psychosis | 28 (35.0%) | 30 (34.5%) | 0.5% | 26 (45.6%) | 21 (38.9%) | 6.7% |
| Cognitive impairment | 0 (0.0%) | 2 (2.3%) | −2.3% | 0 (0.0%) | 3 (5.6%) | −5.6% |
| MS-related treatments | ||||||
| Plasmapheresis | 0 (0.0%) | 0 (0.0%) | 0.0% | 0 (0.0%) | 1 (1.9%) | −1.9% |
| Intravenous immunoglobulin | 1 (1.3%) | 1 (1.1%) | 0.1% | 0 (0.0%) | 0 (0.0%) | 0.0% |
| Other disease-modifying therapy | 35 (43.8%) | 35 (40.2%) | 3.5% | 26 (45.6%) | 22 (40.7%) | 4.9% |
| Rehabilitation and physical therapy services | ||||||
| Patients with ≥ 1 rehab/physical therapy claim | 7 (8.8%) | 11 (12.6%) | −3.9% | 7 (12.3%) | 6 (11.1%) | 1.2% |
| Number of rehab/physical therapy claims | 16.9 ± 18.8 [6] | 20.2 ± 21.3 [13] | −3.32 | 11.3 ± 17.2 [3] | 18.8 ± 37.4 [4] | −7.55 |
| Mobility indicators | ||||||
| Overall | 8 (10.0%) | 14 (16.1%) | −6.1% | 12 (21.1%) | 7 (13.0%) | 8.1% |
| Cane/crutch | 0 (0.0%) | 2 (2.3%) | −2.3% | 0 (0.0%) | 0 (0.0%) | 0.0% |
| Dalfampridine (Ampyra) | 7 (8.8%) | 8 (9.2%) | −0.4% | 12 (21.1%) | 6 (11.1%) | 9.9% |
| Specialty bed | 0 (0.0%) | 0 (0.0%) | 0.0% | 0 (0.0%) | 1 (1.9%) | −1.9% |
| Walker | 1 (1.3%) | 2 (2.3%) | −1.0% | 0 (0.0%) | 0 (0.0%) | 0.0% |
| Wheelchair | 0 (0.0%) | 2 (2.3%) | −2.3% | 0 (0.0%) | 1 (1.9%) | −1.9% |
| EDSS-derived disability claims | 2.5 ± 4.3 [0] | 3.8 ± 4.7 [1] | −1.29 | 6.6 ± 8.0 [3] | 7.1 ± 8.2 [6] | −0.44 |
| Procedures | ||||||
| MRI | 32 (40.0%) | 34 (39.1%) | 0.9% | 20 (35.1%) | 14 (25.9%) | 9.2% |
| All-cause healthcare resource use | ||||||
| ≥ 1 visit | ||||||
| Inpatient | 7 (8.8%) | 17 (19.5%) | −10.8% | 16 (28.1%) | 18 (33.3%) | −5.3% |
| Outpatient/physician office | 72 (90.0%) | 79 (90.8%) | −0.8% | 51 (89.5%) | 49 (90.7%) | −1.3% |
| Surgery | 0 (0.0%) | 4 (4.6%) | −4.6% | 4 (7.0%) | 5 (9.3%) | −2.2% |
| Other visitsb | 33 (41.3%) | 41 (47.1%) | −5.9% | 30 (52.6%) | 19 (35.2%) | 17.4% |
| Visits | ||||||
| Inpatient admissions | 1.4 ± 0.8 [1] | 1.3 ± 0.5 [1] | 0.13 | 1.6 ± 0.9 [1] | 2.2 ± 1.4 [2] | −0.60 |
| Length of stay (days) | 3.7 ± 2.8 [4] | 4.9 ± 7.5 [3] | −1.23 | 4.6 ± 4.7 [3] | 4.3 ± 3.5 [4] | 0.29 |
| Surgery | – | – | – | 1.0 ± 0.0 [1] | 1.4 ± 0.9 [1] | −0.40 |
| Outpatient/physician office visits | 8.5 ± 9.4 [5] | 10.0 ± 9.8 [7] | −1.51 | 8.6 ± 8.0 [5] | 8.4 ± 7.4 [6] | 0.14 |
| Other visits | 3.6 ± 3.7 [2] | 5.5 ± 6.0 [3] | −1.90 | 5.5 ± 5.8 [3] | 10.7 ± 12.1 [6] | −5.22 |
| Visits with MS relapse diagnosis | 0.3 ± 0.7 [0] | 0.6 ± 1.5 [0] | −0.31 | 0.8 ± 1.5 [0] | 0.5 ± 0.8 [0] | 0.27 |
| Prescription drug use | ||||||
| Corticosteroids | 34 (42.5%) | 46 (52.9%) | −10.4% | 22 (38.6%) | 21 (38.9%) | −0.3% |
| Average daily corticosteroid dose (mg) | 0.7 ± 1.9 [0] | 1.6 ± 4.0 [0] | −0.90 | 0.8 ± 1.9 [0] | 1.5 ± 3.7 [0] | −0.63 |
| Number of prescriptions filled | 38.9 ± 25.5 [35] | 41.3 ± 31.4 [35] | −2.35 | 59.9 ± 49.2 [53] | 60.8 ± 56.9 [37] | −0.96 |
| Number of unique drugs | 16.7 ± 8.4 [16] | 15.9 ± 10.9 [14] | 0.85 | 20.7 ± 14.5 [17] | 20.2 ± 15.8 [14] | 0.46 |
HCRU healthcare resource utilization, SD standard deviation, EDSS Expanded Disability Status Scale
a Denied patients are propensity score matched (± ¼ SD) 1:1 to approved patients. The matching criteria include all baseline characteristics reported in the baseline tables
b The Symphony data list all visits that are not inpatient, outpatient, or surgery as “other”