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VBCN - July 2015 Volume 2, No 2 - Health Economics
Chase Doyle

Indianapolis, IN—Two cross-sectional studies of the decision-making process, insurance coverage and disease-modifying therapy (DMT) choices of patients with multiple sclerosis, provide glimpses of patients’ preferences.

For example, 43.5% of patients who had recently changed their DMTs had done so because of insurance coverage change, insurance denial, or higher copays. And older patients were more likely than younger patients to let their physicians have a large role in clinical decision-making.

Lead researcher Stacey S. Cofield, PhD, Associate Professor of Biostatistics, University of Alabama at Birmingham School of Public Health, and colleagues presented their findings at the 2015 Consortium of Multiple Sclerosis Centers annual meeting.

The studies are based on data from the fall 2014 update survey of the North American Research Committee on Multiple Sclerosis. The database contains self-reported information on DMTs, income, insurance, disease status, and reasons for treatment changes.

In one study, Dr Cofield’s team focused on the interactions between the use of DMTs, insurance status, and health and financial status. Virtually all (99.4%) of the 6662 patients surveyed were currently insured. Some 22.1% of patients reported that their insurance status had worsened in the previous 6 months. Furthermore, among the 4156 (62.4%) patients who provided information on how they pay for DMTs, 22.2% had full coverage, 52.1% paid only the copay, and 25% used a free or discounted drug program.

Fewer patients with relapsing-remitting multiple sclerosis paid the whole cost of their DMTs out of pocket than patients who paid only some or none of the cost. Furthermore, among the 398 patients who had changed the type or dosage of their DMT, 22.4% had changed because of insurance denial, 12.8% said a higher copay had caused them to skip or split their DMT, and 8.3% said the reason for the DMT change was an insurance change.

The other study focused on the Control Preferences Scale, which consists of 5 images showing different patient or physician roles in treatment decision-making, ranging from A—depicting the patient preferring to make the final treatment decision—to E—in which the patient prefers to leave all treatment decisions to his or her physician.

Most patients chose B, in which the patient prefers to make the final treatment decision after seriously considering the doctor’s opinion (39.9%), or C—shared decision-making (44.06%).

The results also indicated that the average age was lower among those choosing A (58.7 years) versus E (64.1 years). Those who preferred more independence in their decision-making also had a shorter disease duration (20.3 vs 23.3 months, respectively), lower patient-determined disease step (4 vs 5), and more DMT use in the previous 6 months (263 vs 88).

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Last modified: August 5, 2015
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