Comparison between specialty pharmacy care and usual pharmacy care on health outcomes and costs among multiple sclerosis patients.

摘要

Background. It has become a growing trend in health care for the third-party payers to require specialty therapeutic management in multiple sclerosis (MS) patients to help patients adhere to their prescribed specialty medications. However, researchers have not paid much attention to the effects of specialty pharmacy care on this debilitating disease.;Objective. This study aimed to compare administrative claims data from MS patients' that used specialty pharmacy care and usual pharmacy care to assess the cost effectiveness of pharmacy services management. The study analyzed patients' relapse status, adherence to pharmacy therapy, medical services utilization, and health care costs.;Methods. Administrative claims for people with MS were extracted from the databases from a pharmacy management company for this retrospective cohort study. Enrollees with continuous pharmacy benefit eligibility were followed for three years. Patients exposed to any specialty pharmacy care programs were classified as the specialty pharmacy care group; others were classified as the usual pharmacy care group. MS relapses were considered to have occurred when patients used steroids or were hospitalized due to MS. The outcome measures included risk of and number of relapses, and time to relapse. Logistic, negative binomial, and Cox proportional hazards regression models were performed to compare between groups. Direct medical cost, drug cost, and total cost of care of the 3-year study period were also assessed. Total healthcare cost consisted of both medical and pharmacy components. Incremental cost-effectiveness ratios (ICER) of an additional relapse-free day and each relapse avoided were also computed.;Results. The study cohort consisted of 1,731 eligible MS patients, of which 1,427 received the specialty pharmacy care. During the study period, 1,634 relapses were identified with a mean annual relapse rate of 0.3 among the specialty pharmacy care group versus 0.4 among the usual pharmacy care group. In the unadjusted model, specialty pharmacy care was associated with a lower risk of developing MS relapses with risk ratios (RRs) of 0.813 for any relapse and 0.765 for multiple relapses and hazard ratios (HRs) of 0.727 for the first relapse and 0.782 for the second relapse. After adjusting for the demographics, comorbidities, and index medications, specialty pharmacy care was associated with lower risk of MS relapses with RRs of 0.761 for any relapses and 0.712 for multiple relapses and lower HRs of 0.674 for the first relapse and of 0.741 for the second relapse, compared to usual pharmacy care. In a secondary analysis, health services utilization was added as a predictor in the case of time to relapses. The specialty pharmacy care was associated with lower risk to the first relapse and the second relapse with HRs of 0.806 and 0.914, respectively. A similar comparison was also made on drug cost and medical costs between different pharmacy care types in which drug cost was US;Conclusion. Over the three-year study period, specialty pharmacy care was associated with significantly lower risk for relapses, fewer MS relapses, longer relapse-free time; improved medication adherence; and lower medical cost, but higher drug cost. The cost savings in medical cost did not offset the drug cost in specialty pharmacy care. No sufficient evidence shows that specialty pharmacy care was associated with reduced total health care cost over the 3-year study period.