Health care services and disease modifying therapies use in community-based multiple sclerosis patients: Evolution...

Multiple sclerosis (MS) disease modifying therapies (DMT) utilization increased during the last decade with the approval of new drugs. Symptomatic treatments also play an important role. Describing time trends and demographic characteristics for DMT and symptomatic treatments utilization in population-based MS patients will lead to a better knowledge of the resources distribution.

Repeated cross-sectional analysis on each calendar year were implemented retrospectively on the health insurance claims database in France from 2013 until 2015 regarding DMT, fampridine, fluoxetine, psychiatrist office visits, and Physical therapy sessions to calculate an utilization rate defined as the number of MS patients (whenever the date of diagnosis) who filled at least 1 prescription or service within the studied calendar year per cent MS patients covered the same calendar year (number of users per cent MS population per annum). Beneficiaries with MS were identified by their exemption of co-payment for long-term disease (ALD).

DMT utilization rate increased from 34.22% in 2013 to 38.73% in 2015. The increase was due to recently developed DMT as first-generation DMT utilization rate decreased from 30.20% to 20.06%. Rates were not different between genders but significantly decreased with age. The average age of users was significantly lower for DMT than for symptomatic treatments (recently developed DMT: 43.63, first-generation DMT: 45.84, psychiatrist office visits: 49.08, Fampyra^®: 55.41, Physical therapy sessions: 55.88, fluoxetine: 58.26). Regional DMT utilization rates ranged from 31.68% in Auvergne-Rhône-Alpes to 42.58% in Normandie. They were not correlated to regional rates of MS prevalence (R-Square=0.0558; P=0.2556) nor to the presence of a MS reference centre in the region (Chi-Square=0.0190; P=0.8905). In 2015 the six DMTs with the highest rates were by decreasing orders: Tecfidera^®, Avonex^®, Gilenya^®, Aubagio^®, Copaxone^®, and Rebif^®. Half of them were recently developed orally-administered drugs.

Complex factors may explain the interprovincial variability. Low DMT utilization rates in the most aged patients who also have the highest recourse rate to symptomatic treatments reflect the fact that the indication of disease modifying therapies do not address older patient's needs. New DMTs with medical indications for the late degenerative phase are needed.