Disability, Economic Burden Greater in MS Patients With High Levels of Fatigue

Hoa Le, PhD

Results from a cross-sectional study presented at MS Virtual 2020, the 8th Joint ECTRIMS-ACTRIMS meeting, September 11–13, 2020, revealed that patients with relapsing-remitting multiple sclerosis (RRMS) who were stratified by high levels of fatigue (RRMS+HF) had greater comorbidity and economic burdens compared with those with low fatigue (RRMS+LF) and individuals without MS.¹

Hoa H. Le, PhD, associate director, Real World Value and Evidence, Janssen Pharmaceuticals, presented the findings and noted that they can facilitate identification of patients with MS who may require additional treatment and support to manage MS-related fatigue. The data showed that the annualized number of outpatient visits, emergency room visits, and hospitalizations were greater for those with RRMS+HF (15.5 [±15.4]; 1.3 [±3.5]; 0.9 [±2.6]) compared to those with RRMS+LF (11.5 [±17.6]; 0.7 [±2.0]; 0.4 [±1.6]) and non-MS (7.4 [±11.3]; 0.5 [±2.5]; 0.4 [±2.8]) groups.

To fully describe demographics, comorbidities, and healthcare resources of adults with RRMS with low levels and high levels of fatigue, investigators analyzed 123 respondents with RRMS+HF, 375 with RRMS+LF, and 145,669 non-MS controls. The mean age among the 3 groups was similar, with females comprising of 75%, 74%, and 55% of the groups.

Annual medical costs of $19,508 (±$43,614) were recorded for those with RRMS+HF compared with $10,406 (±$28,081) for those with RRMS±LF and $8,493 (±$45,661) for those without MS. Full-time employment was reported in 18%, 31%, and 43% of those with RRMS+HF, RRMS+LF, and non-MS participants, respectively. Notably, those with RRMS+HF were more likely to have lower annual household income.

Higher Charlson Comorbidity Index scores were reported by patients with RRMS+HF (1.2 [±1.8]), compared to RRMS+LF (0.7 [±2.9]) and those without MS (0.4 [±1.0]). Additionally, long-term disability was reported in 38%, 14%, and 3% of patients within each group, respectively.

Depression was reported in 65% of patients with RRMS+HF compared with 33% of those with RRMS+LF and 20% of healthy controls. Furthermore, investigators noted that anxiety was more commonly reported in those with RRMS+HF than RRMS+LF and non-MS patients (48% vs 25% and 19%, respectively). Insomnia was also reported in 26% of patients with RRMS+HF, 16% with RRMS+LF, and 8% of those without MS.

The economic burden associated with MS has been well documented. Recent data collected from the Harvey L. Neiman Health Policy Institute showed that over 75% of patients with MS face financial toxicity, with higher risk for patients with MS who have lower financial self-efficacy and prior relapse history.²

The data showed that decreases in income after receiving an MS diagnosis were reported by 56.2% (n = 127) of patients, with 37.1% (n = 74) experiencing a decrease greater than 20% of their income. The investigators of that study noted that 67% (n = 136) of patients used at least 1 financial coping strategy in response to financial burden from treatment expenses. Furthermore, 50.4% of those decreased spending on leisure activities, while 40.2% withdrew money from savings accounts and 34.8% decreased basic spending.

In addition, NeurologyLive sat down with Daniel M. Hartung, PharmD, MPH, associate professor of pharmacy, Oregon State University College of Pharmacy, to discuss his findings from a report on rising spending in the US Medicaid program on disease-modifying therapies for MS, and the unique nature of their prices in the United States. Click below to listen to the conversation.

For more coverage of MS Virtual 2020, click here.​

REFERENCES

1. Le H, Ken-Opurum J, Maculaitis M, Sheehan J. Comorbidity and economic burdens of fatigue among patients with relapsing-remitting multiple sclerosis in the United States. Presented at: MS Virtual 2020 Joint ACTRIMS-ECTRIMS meeting, September 11–13, 2020. Abstract P0857.

2. Sadigh G, Lava N, Switchenko J, et al. Patient-reported financial toxicity in multiple sclerosis: predictors and association with care non-adherence. J Mult Scler. Published online August 18, 2020. doi: 10.1177/1352458520913977​