Real-world cost of treatment for multiple sclerosis patients initiating and receiving infused disease-modifying therapies per recommended label in the United States

Abstract

Aims: The study evaluated the real-world cost of treatment in multiple sclerosis (MS) patients initiating infused disease-modifying-therapies (DMT) in the United States.

Materials and Methods: This retrospective cohort study using administrative claims data included adult patients with MS initiating index infusion DMT (ocrelizumab (OCR), natalizumab (NTZ) or alemtuzumab (ATZ)) from April 2017–September 2018 with 6-months pre/12-months post-index continuous enrollment. The primary cohort included patients who had prescribed annual dosing visits indicated by the approved product label (PL): 3 OCR, 5 ATZ, and 12–13 NTZ infusion visits within the first year of initiation. Annual treatment cost was the sum of all costs on index DMT infusion visit dates. Costs were summarized for a primary and secondary cohort of patients receiving additional doses than prescribed in PL (>3 OCR, >5 ATZ, and >13 NTZ infusion visits); and an overall cohort of patients who met minimum required annual dose (≥3 OCR, ≥5 ATZ, and ≥12 NTZ), further stratified by insurance type.

Results: For patients in the primary cohort (123 OCR, 18 ATZ, and 48 NTZ), mean (standard-deviation) annual cost of treatment with OCR, ATZ, and NTZ cohorts was $72,066 ($34,480), $121,053 ($51,097) and $93,777 ($38,815), respectively. Among patients initiating OCR and NTZ, 15 and 6% respectively, had additional infusion visits leading to greater costs. Mean annual costs of index infusion DMT treatment in the overall cohort (162 patients treated with OCR, 18 with ATZ, 56 with NTZ) were $80,582, $121,053, and $93,807, respectively. The mean costs for commercial enrollees were higher than those for MAPD enrollees.

Limitations: Small sample size, limited population generalizability, and cost-reduction for ATZ beyond the second year need to be accounted for.

Conclusions: Real-world infusion DMT treatment costs for commercially insured patients were higher than perceived expenditures based on wholesale acquisition cost and administration costs via a physician-fee schedule. Consideration of real-world costs in cost-effectiveness and treatment/coverage decisions is needed.     

Environmental policy integration as a strategy for sustainable tourism planning: issues in implementation

Both in a national and global context, it is challenging to identify key conditions for the integration of sustainable tourism in public policy. By studying a number of recent planning processes pertaining to tourism development, this article aims to contribute recent insight into how sustainability may be integrated into tourism planning. The study was motivated by a publicized shift in the Norwegian government policy strategy on sustainable tourism, from a sector approach to an integration approach. Through case analysis, the concept of environmental policy integration is applied. Findings show that sustainable tourism is partially integrated in all cases and three key issues are outlined. First, although Norway is characterized by a high degree of sector organization, it has a weak structure for overall tourism policy integration. Second, the integration of sustainable tourism has been stimulated by national horizontal integration, bottom-up integration prepared by institutional changes, public participation, and by active use of the municipal system of planning. Third, this study could not find any evidence for the announced shift from a sector approach to an integrated approach to sustainable tourism.     

Local Versus Visitor Perceptions of Farmers’ Markets

There has been an increasing focus on the local food movement and farmers’ markets that supply this food. Most studies have focused on profiling the consumer or motivations for purchasing local food; however, few have focused on the differences in those who frequent such tourism offerings. The purpose of this research study, therefore, was to examine differences between visitors and residents regarding motivations and preferences for buying local and organic food at farmers’ markets. There has been an increasing focus on the local food market due to food security awareness, consumer responsibility, and food trends such as the 100-mile diet and preference of local and organic. Using 322 completed surveys, responses were analyzed to examine significant differences. The results show a difference in motivations of visitors and locals in regard to their frequenting of farmers markets, as well as the frequency of their use. Increasingly within tourism there has been a focus on the local or authentic tourism experience; therefore, understanding the differences in visitor preferences may help both destinations and the markets themselves to cater to different preferences among their clientele.     

Becoming a green entrepreneur: An advanced entrepreneurial cognition model based on a practiced-based approach

International Entrepreneurship and Management Journal - This paper examines how entrepreneurs develop the intention to make their venture green, even when “being green” doesn’t...     

Global talent management by multinational enterprises post-COVID-19: The role of enterprise social networking and senior leadership

Multinational enterprises' (MNEs') workforce is made up of people from diverse backgrounds and different locations around the globe. The cross-border transfer of knowledge, skills, and best practices among MNE employees is important to maintain global standards and competitiveness. In the post-COVID-19 period, there is a greater need to exchange knowledge in the changing business environment. The purpose of this study is to examine the issues related to MNEs' global talent management, post-COVID-19. The study investigates the use of enterprise social networking applications for better knowledge exchange and tries to understand the moderating role of senior leadership team support in facilitating the usage of enterprise social networks for cross-border collaboration and talent management. After reviewing the literature and relevant theories, we developed a conceptual model, which is then validated using the SEM technique with 347 respondents from 12 MNEs. The study reveals the importance of using enterprise social networks for cross-border knowledge exchange in the post-COVID-19 period.     

Navigating the internationalization process: Strategic resources for early internationalizing firms

Journal of International Entrepreneurship - Despite an increasing number of studies identifying factors that influence the internationalization process for early internationalizing firms (EIFs), it...     

The Destination Marketing Organization as an intelligent agent: Evaluating engagement in knowledge management practices

DMOs have been increasingly called upon to adopt the role of knowledge management, becoming intelligent agents with the capacity to gather, assess, and disseminate information among internal and external stakeholders. While knowledge management has remained a prominent topic in the literature, its application within the field of tourism management has been limited. The purpose of this study, therefore, was to ascertain to what extent DMOs have engaged in knowledge management practices through a nation-wide survey of 30 Canadian DMOs. The results demonstrate that, while DMOs have made progress toward becoming intelligent agents, there remains a long way to go.     

An inspector calls: farm accommodation providers' attitudes to quality assurance schemes in the county of Devon

Estimates suggest that 10 000 farms in the UK offer bed and breakfast (B and B) serviced accommodation. A thorough review of the existing literature indicates over 50% of Devon and Cornwall's farmhouse B and B sector operate without participating in any form of quality assurance inspection scheme. This research executes a stratified postal survey to gain a comprehensive understanding of Devon's farmhouse B and B product, with particular interest in extracting providers' attitudes towards quality assurance inspection schemes. The very representative results suggest a divergence of attitudes towards the notion of quality inspections for all farmhouse B and B providers. Copyright © 2002 John Wiley & Sons, Ltd.