Examining ocrelizumab sites of care and costs in real-world presents cost-saving opportunity in multiple sclerosis

The cost of a common multiple sclerosis (MS) drug varies widely across different sites of care. Administration of the medication at home or a physician office could result in significant cost savings and convenience for patients.

Enterprise Analytics Core domain(s): Costs of care, CarelonRx, policy guidance

Summary

Background

Ocrelizumab has been a frequently used and costly treatment in MS management since its approval in April of 2017. This study explored the costs of ocrelizumab in various site-of-care settings and trends in ocrelizumab site of care over time.

Methods

We used administrative claims data from April 2017 to June 2020 to examine ocrelizumab costs and site-of-care trends.

Results

For ocrelizumab users, outpatient hospital appeared to be the most common and costly site of care, followed by physician office, and home setting—being the least common and least expensive (Figure 1).
While the proportion of outpatient hospital as site of care decreased over time (from 75.7% to 60.0%), it still accounted for over half of the ocrelizumab use settings (Figure 2).

Figure 1. Mean Ocrelizumab Costs by Site of Care (Patient-Level Analysis)
MS Study Figure 1.jpg

Figure 2. Trends in the Site of Care for Ocrelizumab (Claims-Level Analysis)
MS Study Figure 2.jpg

Key takeaway

This presents an opportunity for Elevance Health to save costs and optimize the site of administration of ocrelizumab from the outpatient hospital setting to a less expensive site of care (physician office/home setting).

Publication

Poster presented at the Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, October 25-28, 2021.

Carelon Research project team: Nicole Gabler, Kapil Rathi*, Hiangkiat (Jason) Tan

*Carelon Research Associate at the time of the study.

For more information on a specific study or to connect with the Actionable Insights Committee, contact us at [email protected].

This study was conducted by Carelon Research, a subsidiary of Elevance Health, and funded by Novartis. Dissemination and sharing of the Newsletter is limited to Elevance Health and its subsidiaries and included findings and implications are for Elevance Health and its affiliates’ internal use only.

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Highlighted Studies

A real-world study of immunoglobulin (IG) reveals multiple cost-saving opportunities

Hub Domain(s): Immunology, oncology, costs of care, IngenioRx, policy guidance
Summary:

Background: Immunoglobulins (IG) are costly blood-derived products accounting for more than $500m in annual spending in the Anthem membership
Methods: HealthCore examined IG utilization using claims data to evaluate appropriateness of use, the extent of site-of-care optimization and non-preferred IG use.
Results: The findings revealed significant off-label use of IGs (30%), including 22% for indications that were neither approved by FDA nor covered by Anthem, but were accepted by other health plans; and 8% for indications that were neither approved by FDA nor covered by any health plan

Additionally, 25% of the IG use was observed in the most expensive site of administration of hospital outpatient (HOPD) and non-preferred IG use accounted for 71% of the total IG use

Key Takeaways: Examining the IG uses from various dimensions presents several opportunities to IngenioRx and Anthem:

Reducing off-label IG use represented an estimated $27.8m annual savings opportunity
Shifting IG utilization from HOPD to a less expensive site of care could drive a further estimated $6.3m in annual savings
The study also identified opportunities to increase the share of preferred IG products used by our patients.

Major depressive disorder (MDD) patients highly impacted by COVID-19 face daunting challenges

Hub Domain(s): COVID, member experience
Summary:

Background: Disruption to daily life and lockdown measures that were imposed in an attempt to contain the spread of COVID-19 presented new hurdles for at-risk populations, such as patients with major depressive disorder (MDD)
Methods: Conducted a 2020 internet survey to understand reasons for antidepressant continuation, switching and discontinuation in patients with MDD; COVID-19 pandemic questions were developed and added to survey.

COVID-19 Pandemic Impact (CPI) score was calculated and, based on their CPI scores, patients were categorized as experiencing low (LPI), medium (MPI) or high pandemic impact (HPI).

Results: Compared with LPI and MPI patients, HPI patients reported:

Significantly more problems accessing healthcare; few reported not having health insurance benefits due to loss of/reduced health insurance coverage (Figure 1).
More challenges obtaining depression prescription medications in terms of:

Filling new/current prescription(s)
Receiving samples from healthcare providers
Paying for prescription(s) due to loss of/reduced health insurance coverage and/or pharmacy benefits

Since start of COVID-19 pandemic engaged in significantly more:

Alcohol, drug, and tobacco use
Unhealthy mindless eating
Sedentary behavior

Key Takeaways: Our findings are consistent with literature showing that traumatic events, e.g. pandemics, can negatively impact health behaviors.

More research is needed to explore the COVID-19 impact in other patient populations.
Education opportunities exist for health plans to increase awareness among providers and patients of possible short and long-term COVID-19 effects on health behaviors.

Figure 1: Impact of COVID-19 pandemic on accessing healthcare/mental healthcare

Publications: Poster presented at the Virtual American Society of Clinical Psychopharmacology (ASCP) Annual Meeting, June 1-4, 2021

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Actionable Insights Newsletter
Translating research to power whole health

Issue 4 | November 2022