Multiple sclerosis patients’ preferences: econometric evaluation of therapeutic compliance.

Presenter: Lara Gitto, University of Roma "Tor Vergata" & University of Messina

Abstract

Rationale:

Multiple sclerosis (MS) is a chronic, disabling, and progressive illness. There is not a definitive treatment for MS yet. Disease-modifying drugs (DMDs), which include interferon-beta (IFN-b) and copolymer-1 have shown to be effective in reducing the frequency of exacerbations and the progression of disability.

However, adverse drug effects, the need to assume the medicines very often, and the lack of communication between physicians and patients, might affect compliance of the latter to the therapy: patients might decide to stop the treatment, with relevant consequences, both medical and economic, because of the likely progression of the disease.

This research is an absolute novelty among the existing economic and medical literature. In fact, the factors underlying the decision to start the pharmacological treatment, to continue it or to drop out, have not been studied so far.

Objectives:

Primary objectives of the research:

- To outline the factors, related to patients’ perception and awareness of the disease and of potential benefits associated with pharmacological treatment, that may have an impact on the decision to start DMDs treatment.

- To identify potential indicators of poor pharmacological compliance in patients with MS.

Secondary goal:

- To create a set of best-practice protocols for physicians and patients, directed at improving communication on the most relevant aspects of the disease and the treatment.

Methodology:

935 patients diagnosed with MS have been initially considered at the IRCCS Centro Neurolesi “Bonino-Pulejo” (Italy). The final sample was made of 567 patients.

The decision to start a pharmacological treatment with DMDs has been evaluated by applying a multinomial logit model, within the framework of a random utility model.

The second phase of the analysis has been aimed at observing those patients who started the treatment: 143 of these patients have been interviewed. The probability to proceed in the treatment itself or to drop out has been estimated through a probit model.

Results:

The probability that pharmacological treatment will be regularly administered is an index of patients' compliance, as well as of the awareness of the risks associated to the disease.

Length and frequency of relapses, type of symptoms (first of all difficulty in moving and sight problems) and the circumstance that the patient has been recently hospitalized show an impact in determining the decision to start the treatment with DMDs.

Instead, the distance between patients’ home towns and side effects due to the pharmacological treatment often determine the decision to drop out.

A high probability of dropping out signal the need to correct the approach used with the patients, including type and quality of information to provide.

Conclusions:

The paper provides useful information for:

1) the NHS, because a clear knowledge of the factors likely to induce a limited compliance and, consequently, to determine a higher probability of relapses for MS patients, may help in planning and allocating resources, contain costs and reduce wastes.

2) Physicians, because knowing those factors perceived to be most critical in undergoing the treatment with DMDs may help them to implement effective communication strategies.

3) Patients. The results of the study shed light on their preferences and may lead, as a consequence, to a better quality of life.