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The effect of national disease-modifying therapy subsidy policy on long-term disability outcomes in people with multiple sclerosis

Citation

Claflin, SB and Campbell, JA and Mason, DF and Kalincik, T and Simpson-Yap, S and Norman, R and Butzkueven, H and Carroll, WM and Palmer, AJ and Blizzard, CL and van der Mei, I and Taylor, BV, The effect of national disease-modifying therapy subsidy policy on long-term disability outcomes in people with multiple sclerosis, Multiple Sclerosis Article online ahead of publication. ISSN 1352-4585 (2021) [Refereed Article]

Copyright Statement

The Author(s), 2021.

DOI: doi:10.1177/13524585211035948

Abstract

Background: Disease-modifying therapies (DMTs) are used to treat people with relapsing-onset multiple sclerosis (ROMS), but our knowledge is largely limited to their short-term effects.

Objective: To determine (1) the impact of national-level DMT subsidy policy on DMT use and health outcomes in people with MS (PwMS) and (2) the long-term effects of DMT on disability and quality of life (QoL; 5-level EQ-5D version (EQ-5D-5L) utility value).

Methods: This observational cohort study compared Australian and New Zealand populations with different levels of DMT availability 10-20 years post-ROMS diagnosis. Between-country differences were assessed using standardised differences. Associations were assessed with multivariable linear regression models.

Results: We recruited 328 Australians and 256 New Zealanders. The Australian cohort had longer DMT treatment duration, greater proportion of disease course treated and shorter duration between diagnosis and starting DMT. The Australian cohort had lower median Expanded Disability Status Scale (EDSS) (3.5 vs 4.0) and Multiple Sclerosis Severity Score (MSSS) (3.05 vs 3.71) and higher QoL (0.71 vs 0.65). In multivariable models, between-country differences in disability and QoL were largely attributed to differential use of DMT.

Conclusions: This study provides evidence for the impact of national-level DMT policy on disability outcomes in PwMS. Where DMTs are more accessible, PwMS experienced less disability progression and improved QoL 10-20 years post-diagnosis.

Item Details

Item Type:Refereed Article
Keywords:multiple sclerosis, neurology, disease-modifying therapy, health policy
Research Division:Biomedical and Clinical Sciences
Research Group:Neurosciences
Research Field:Neurology and neuromuscular diseases
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Health policy evaluation
UTAS Author:Claflin, SB (Dr Suzi Claflin)
UTAS Author:Campbell, JA (Dr Julie Campbell)
UTAS Author:Simpson-Yap, S (Dr Steve Simpson JR)
UTAS Author:Palmer, AJ (Professor Andrew Palmer)
UTAS Author:Blizzard, CL (Professor Leigh Blizzard)
UTAS Author:van der Mei, I (Professor Ingrid van der Mei)
UTAS Author:Taylor, BV (Professor Bruce Taylor)
ID Code:147022
Year Published:2021
Deposited By:Menzies Institute for Medical Research
Deposited On:2021-10-10
Last Modified:2021-11-22
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