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Background:Multiple Sclerosis is a chronic, disabling disease that nearly affects one million patients in America. It is associated with high economic burden due to its high prescription prices, increased healthcare resource utilization, and indirect costs. More than 90% of the patients are covered by health insurance; however, there is limited data that compares healthcare resource utilization and out-of-pocket expenses across different insurance groups in patients with Multiple sclerosis in the U.S. Goal and aims:The main goal of this study was to assess how healthcare resource utilization and out-of-pocket costs differ across different insurance statuses in patients with Multiple sclerosis. Our aims were fourfold. First was to estimate the healthcare resource utilization in each insurance group. Second was to estimate the out-of-pocket costs for each insurance coverage. Third was to identify key factors associated with healthcare resource utilization and out-of-pocket costs. And our final aim was to compare the differences in healthcare resource utilization and out-of-pocket expenditure between different insurance statuses. Methods:This was a retrospective cross-sectional study that analyzed the Medical Expenditure Panel Survey database from the year 2010 to 2015. We used the ICD-9-CM code of 350 and CCCODEX of 080 to identify patients with Multiple Sclerosis. Weighted descriptive statistics was used to represent healthcare resource utilization and out-of-pocket expenses. Kruskal Wallis and ANOVA tests were utilized to determine if the differences between insurance statuses were statistically significant. Negative binomial regression models were used to analyze healthcare resource utilization, while two-part mixed models were used for out-of-pocket costs.Results:Insurance status affected the utilization of some of the healthcare resources and out-of-pocket expenditures. Medicaid and/or other insured beneficiaries received greater home healthcare service compared to Medicare and privately insured patients (p= 0.0033). When adjusting for other covariates, Medicare patients had around 2.7 times outpatient visits and 0.6 times office visits compared to privately insured patients. Insurance significantly impacted prescriptions out-of-pocket payments. Medicaid and/or other insured patients spent around $418 in contrast to $1300 spent by Medicare enrollees, and $1655.70 spent by privately insured patients. Total out-of-pocket payments were widely variable across different insurance groups, where privately insured patients paid $2436.20 in comparison to Medicaid and /or other insured patients who spent $1208.33. Other variables that significantly impacted healthcare resource utilization include age, ethnicity, and comorbidities. On the other hand, age, ethnicity, race, and geographic region were the main key determinants that influenced out-of-pocket payments. Conclusion:There were disparities in healthcare resource utilization and wide variability in total out-of-pocket expenditures among different insurance groups in the MS population. Age, ethnicity, and geographic regions were among key factors that influenced our outcomes. Disparities in healthcare services and out-of-pocket payments are compelling problems that need to be addressed by healthcare policymakers to ensure equitable and affordable access to all patients with MS. |
