Recent transition of medical cost and relapse rate of multiple sclerosis in Japan based on analysis of a health insurance claims database
Abstract Background In this study, we aimed to understand the trends in total and itemized medical expenses, especially of disease-modifying therapy (DMT), for multiple sclerosis (MS) in Japan through an analysis of health insurance claims data. Methods We analyzed a database containing health insurance claims data from hospitals that have adopted the Diagnosis Procedure Combination/Per-Diem Payment System in Japan. According to an algorithm based on diagnosis codes, data for all patients diagnosed with MS from April 2008 to July 2016 were extracted. Medical costs, rate of each medical treatment, and rate of relapses were analyzed by calendar-year. Medical costs in the month of relapse were compared with average medical costs per month of all MS patients by a cross-sectional analysis. Results 4,374 MS patients were identified in the database. Total medical cost per patient per month (PPPM) increased from \87,640 (US$787.7 or €723.0 as of May 2017) to \102,846 (US$924.4 or €848.4) during the study period. This increment was mainly attributed to the growth in cost of outpatient DMT prescriptions, which increased from \23,039 (US$207.1 or €190.1) to \51,351 (US$461.5 or €423.6). In contrast, the rate of hospitalizations and relapses PPPM decreased during the study period (from 0.053 to 0.030, and 0.032 to 0.019, respectively). Medical costs in the month of relapse (\424,661, US$3816.8 or €3503.1) were 3.57 times higher than the average monthly costs for all MS patients (\119,021, US$1069.8 or €981.8), with the majority comprising hospitalization cost. Conclusion Concomitant with the increased usage of DMT, the total medical cost for treating MS is increasing in Japan. However, rates of relapse and hospitalization have shown a decreasing trend. There is currently a lack of evidence for direct causality between DMT and reduction of relapse rates. However, even if DMT cannot be directly shown to be the cause of lower relapse rates and fewer hospitalizations among MS patients, a better quality of life for MS patients and a reduction in hospital costs have been achieved concomitantly with the increasing prevalence of DMT.