Real-World Clinical and Economic Outcomes Among Persons With Multiple Sclerosis Initiating First- Versus Second- or Later-Line Treatment With Ocrelizumab.

INTRODUCTION: Prior research has demonstrated that early treatment with high-efficacy disease-modifying therapies (DMTs), including ocrelizumab (OCR), can reduce relapses and delay disease progression among persons with multiple sclerosis (pwMS) compared with escalation from low-/moderate-efficacy DMTs. However, there is a lack of research examining the impact of early use of OCR on real-world clinical and economic outcomes. This study aimed to evaluate differences in events often associated with a relapse (EOAR) as well as non-DMT healthcare resource use (HCRU) and costs among pwMS who received OCR as a first-line treatment compared with later-line treatment after diagnosis. METHODS: Newly diagnosed adult pwMS were selected from deidentified Optum Market Clarity claims data (study period: January 1, 2015-June 30, 2021). All pwMS were required to have initiated OCR after diagnosis and have 12 months of continuous eligibility prior to diagnosis. The index date was the date of initiation of the first-line DMT after diagnosis. pwMS who initiated OCR as first-line (1L OCR cohort) or a second- or later-line treatment (2L + OCR cohort) were matched 1:1 based on length of continuous eligibility after the first-line DMT and weighted using stabilized inverse probability of treatment. In the follow-up period, differences in outcomes, including annualized EOAR, non-DMT HCRU and costs, were evaluated for pwMS in the 1L vs. 2L + OCR cohorts. RESULTS: The sample included 748 pwMS. During the follow-up period, pwMS in the 1L OCR cohort had a significantly lower annual rate of EOAR compared with pwMS in the 2L + OCR cohort (0.37 vs. 0.56; difference: 0.20 [95% CI 0.08, 0.32]). pwMS in the 1L OCR cohort had a significantly lower probability of any hospitalization within 1 year, fewer non-DMT outpatient visits and lower all-cause and MS-related, non-DMT costs compared with pwMS in the 2L + OCR cohort. CONCLUSIONS: First-line initiation OCR was associated with improvements in clinical and non-DMT economic outcomes compared with later-line initiation of OCR, suggesting that early initiation may benefit both patients and the healthcare system.

Costs associated with the use of multigene panel tests in three solid tumor types and the impact on insurance premiums.

Aim: This study assessed the costs associated with multigene panel tests (MGPTs) in the USA and the impact of coverage on insurance premiums. Materials & methods: We conducted a retrospective claims analysis to estimate total patient costs associated with MGPT use in three solid tumors: advanced non-small-cell lung cancer, advanced melanoma and metastatic colorectal cancer. A decision analytic model was constructed to estimate the premium impact of a 1 million member commercial health plan. Results: In all three tumor types, mean total costs for patients receiving or not receiving MGPTs were not significantly different (p > 0.05). The estimated change in premiums per enrollee per month was estimated to be US$0.040. Conclusion: MGPTs were not associated with higher costs and coverage is expected to have minimal impact on insurance premiums.

Costs & premiums for tests of biomarkers We examined whether using tests for many biomarkers at once in three cancer types would lead to higher costs and increase insurance premiums for patients with private insurance. Using real-world data, we found that use of these tests was not linked to higher costs. Furthermore, we estimated that insurance coverage of these tests would result in small changes to insurance premiums.

Persistence and adherence to ocrelizumab compared with other disease-modifying therapies for multiple sclerosis in U.S. commercial claims data.

BACKGROUND: Ocrelizumab (OCR) is the only disease-modifying therapy (DMT) for both relapsing and primary progressive forms of multiple sclerosis (MS). OCR is given by intravenous (IV) infusion twice a year, which may improve adherence to the dosing schedule relative to other MS DMTs that require more frequent administration. Real-world evidence on the persistence and adherence of patients with MS to OCR compared with other DMTs is limited. OBJECTIVE: To examine the persistence and adherence to OCR compared with other DMTs for MS in the United States. METHODS: This analysis was conducted in the PharMetrics Plus commercial claims database and included patients with MS who initiated a new DMT between April 2017 and September 2018. Patients were required to have health plan enrollment for ≥ 1 year before and after DMT initiation (a subgroup analysis was performed for those with ≥ 18 months' continuous enrollment after DMT initiation). Persistence was defined as not switching to another DMT and having no gap in coverage of the initiated DMT for ≥ 60 days during the postinitiation period. The proportion of days covered (PDC) was calculated as the total days covered by the DMT during the postinitiation period divided by the length of the time period (12 or 18 months); PDC ≥ 0.8 was considered adherent. Multivariable Poisson regression models compared discontinuation (nonpersistence) and nonadherence between OCR users and users of other DMTs grouped by administration route. RESULTS: A total of 4,587 patients (OCR, 1,319; injectable, 1,051; oral, 1,876; other IV, 341) were included. The OCR group had the lowest proportion of patients discontinuing at 12 months (8% vs. 28%, 32%, and 43% for other IV, oral, and injectable, respectively) and the highest mean PDC (93% vs. 76%, 74%, and 69%, respectively). Compared with patients initiating OCR, adjusted relative risks (RR) of 12-month discontinuation were 3.3 (95% CI = 2.3-4.6), 3.8 (95% CI = 3.0-4.9), and 5.5 (95% CI = 4.1-7.5) for patients initiating other IV, oral, and injectable DMTs, respectively. Similarly, patients initiating other IV, oral, and injectable DMTs had RRs of 4.9 (95% CI = 3.6-6.8), 5.1 (95% CI = 3.9-6.6), and 6.8 (95% CI = 5.0-9.3) for 12-month nonadherence compared with OCR. A subgroup of 2,913 patients with 18 months of continuous enrollment had similar trends, with 17% in the OCR group discontinuing compared with 40%, 41%, and 55% in the other IV, oral, and injectable groups, respectively. Trends over 18 months were consistent with the 12-month analysis in adjusted models. CONCLUSIONS: Patients initiating OCR had superior persistence and adherence at 12 and 18 months of follow-up compared with patients initiating other MS DMTs. Long-term persistence and adherence should be monitored as OCR experience accrues in a real-world setting. DISCLOSURES: This study was funded by Genentech (South San Francisco, CA), a member of the Roche Group. Engmann, Sheinson, Bawa, and Ng are employees of Genentech and shareholders of F. Hoffman-La Roche (Basel, Switzerland).