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The Multiple Sclerosis Treatment Optimization Program.

Annette Langer-Gould1, Stephen C Cheng2, Bonnie H Li3

  • 1Department of Neurology, Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles, California, USA.

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|October 18, 2021
PubMed
Summary
This summary is machine-generated.

A health system intervention, the MS Treatment Optimization Program (MSTOP), was designed to reduce multiple sclerosis (MS) treatment costs and improve patient outcomes by optimizing disease-modifying therapy (DMT) use.

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Area of Science:

  • Health services research
  • Pharmacoeconomics
  • Neurology

Background:

  • Escalating costs of multiple sclerosis (MS) disease-modifying treatments (DMTs) pose a significant challenge to healthcare systems.
  • Identifying and addressing gaps in care, such as under-prescribing of highly effective DMTs (HETs), is crucial for improving patient outcomes and managing expenditures.
  • Barriers to optimal MS care include prescriber concerns about side effects, limited health systems science knowledge, pharmaceutical industry influence, and mistrust among stakeholders.

Purpose of the Study:

  • To design and implement a health system-level intervention to reduce escalating MS DMT expenditures.
  • To improve health outcomes for persons with MS (pwMS) through optimized treatment strategies.
  • To develop a scalable model for improving the quality and affordability of MS care.

Main Methods:

  • Stakeholder engagement, pharmacy utilization data review, and electronic health record abstraction were used to identify care gaps and barriers.
  • The MS Treatment Optimization Program (MSTOP) was developed based on identified needs.
  • MSTOP implementation involved a risk-stratified treatment algorithm, an ethical formulary, counter-launch campaigns for new DMTs, and discontinuation of ineffective treatments.

Main Results:

  • Key gaps included under-prescribing of HETs (4.9%) and preferred formulary DMTs (20.9%) among DMT-treated pwMS.
  • Identified barriers included fear of HET side effects, lack of MS-specific knowledge, pharmaceutical influence, and stakeholder mistrust.
  • MSTOP strategies were implemented through education, training, provider access expansion, audit and feedback, and evidence reviews.

Conclusions:

  • Resolving wasteful spending on MS DMTs requires multifaceted strategies.
  • The developed health system intervention (MSTOP) provides a detailed framework for other settings and conditions.
  • Optimizing DMT selection and utilization is essential for both cost containment and improved patient outcomes in MS care.