Influence of Comorbidities on Healthcare Expenditures and Perceived Physical and Mental Health Status Among Adults with Multiple Sclerosis: A Propensity Score-Matched US National-Level Study

Abstract

Sandipan Bhattacharjee,1 Zufan Yegezu,2 Kristin Kollecas,3 Kevin Duhrkopf,3 Lobat Hashemi,3 Nupur Greene3 1Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA; 2Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA; 3Neurology, Immunology, & Inflammation, Sanofi Genzyme, Cambridge, MA, USACorrespondence: Sandipan BhattacharjeeHealth Outcomes Division, College of Pharmacy, The University of Texas at Austin, 2409 University Ave., STOP A1930, Austin, TX, 78712-1120, USATel [phone]Fax [phone]Email [email protected]: To evaluate the effect of comorbidities on healthcare expenditures and perceived physical and mental health status among adults with multiple sclerosis (MS) compared to propensity score-matched non-MS controls.Methods: A retrospective, cross-sectional, matched cohort study was conducted using Medical Expenditure Panel Survey (2005– 2015) data. The base study sample consisted of adults (age ≥ 18 years) who were alive and had positive total healthcare expenditures during the survey calendar year. Adults with MS were propensity-matched (1:1) to non-MS controls based on age, gender, and race/ethnicity using greedy matching algorithm. Healthcare expenditures consisted of total and subtypes of expenditures. Health status consisted of perceived physical and mental health status. Comorbidities were identified using ICD-9-CM and Clinical Classification System codes. Ordinary least squares regression and multinomial logistic regression were used to analyze the healthcare expenditures and health status variables, respectively.Results: Final study sample consisted of 541 adults in each MS and non-MS control groups after propensity score matching. After adjusting for potential confounders, individuals with MS had greater total and subtypes of expenditures compared to non-MS controls, and several comorbidities (eg, depression, hypertension) were significantly associated with increased healthcare expenditures. Yearly average total expenditures (expressed in 2018 US$) were significantly (p< 0.001) higher for adults with MS ($29,396) than propensity score-matched non-MS adults ($7875). Moreover, after adjusting for all individual-level factors, adults with MS experienced 363% (p< 0.001) higher total expenditures compared to propensity score-matched non-MS controls. Individuals with MS were more likely to report poorer physical and good mental health status compared to propensity score-matched non-MS controls, and several comorbidities (eg, anxiety, depression) were significant independent predictors of poorer health status. For example, adults with MS were four times more likely (OR: 4.10, 95% CI: 2.42– 6.96) to report fair/poor physical health status compared to excellent/very good physical health status compared with non-MS controls. Adults with MS were 42% (OR: 1.42, 95% CI: 1.01– 1.99) more likely than propensity score-matched non-MS controls to report good rather than very good or excellent mental health status. However, there was no difference between adults with MS and propensity score-matched non-MS controls in terms of reporting fair or poor than very good or excellent mental health status.Conclusion: Findings from this study indicate substantial economic and health status burdens among adults with MS at the US national-level that are significantly influenced by comorbidities.Keywords: multiple sclerosis, comorbidities, expenditures, physical health status, mental health status, propensity score matching

Keywords

• multiple sclerosis
• comorbidities
• expenditures
• physical health status
• mental health status
• propensity score matching