Characterizing demographics, comorbidities, and costs of care among populations with Duchenne muscular dystrophy with Medicaid and commercial coverage

• Main Authors: Gooch, K.L (Author), Iannaccone, S. (Author), Klimchak, A.C (Author), Popoff, E. (Author), Qian, C. (Author), Szabo, S.M (Author)
• Format: Article
• Language: English
• Published: Academy of Managed Care Pharmacy (AMCP) 2021
• Subjects: adolescent; Adolescent; adult; Adult; anxiety disorder; Article; asthma; autism; behavior disorder; cataract; child; Child; Child, Preschool; clinical assessment; cohort analysis; comorbidity; Comorbidity; controlled study; cystic fibrosis; Databases, Factual; deflazacort; demographics; demography; diabetes mellitus; disease burden; dissociative disorder; Duchenne muscular dystrophy; economics; epilepsy; factual database; female; Female; follow up; fracture; health care; health care cost; Health Care Costs; health care utilization; health insurance; human; Humans; hyperkinesia; infant; Infant; insurance; Insurance Coverage; learning disorder; major clinical study; male; Male; medicaid; Medicaid; medicare; mental disease; mood disorder; muscular dystrophy; Muscular Dystrophy, Duchenne; neurologic disease; newborn; osteoporosis; outcome assessment; patient care; prednisolone; prednisone; preschool child; private sector; Private Sector; respiratory tract disease; Retrospective Studies; retrospective study; school child; somatoform disorder; United States; young adult; Young Adult
• Online Access: View Fulltext in Publisher

 BACKGROUND: Duchenne muscular dystrophy (DMD) is a severe X-linked progressive neurodegenerative disease characterized by loss of ambulation, cardiomyopathy, respiratory insufficiency, and early mortality. Few data are available that describe the direct medical costs among patients with DMD in the United States. OBJECTIVE: To characterize the demographics, comorbidity burden, and direct monthly costs of care among patients with DMD with Medicaid and with commercial insurance coverage. METHODS: IBM MarketScan Commercial and Multi-State Medicaid claims (2013-2018) were used to identify males aged 30 years or under with diagnostic codes for muscular dystrophy or DMD; additional exclusion criteria were applied to identify those with probable DMD. Baseline characteristics and comorbidities were tabulated. The frequency of health care resource use and median (interquartile range [IQR]) monthly costs (in 2018 USD) were estimated from those with at least 12 months of continuous follow-up. RESULTS: Median (IQR) baseline ages were similar between the Medicaid (14 [9-20] years; n=2,007) and commercial (15 [9-21] years; n=1,964) DMD cohorts. The frequency of comorbidities over the period was slightly higher with those on Medicaid. The median duration of follow-up was 3.1 years among members of the Medicaid DMD cohort and 1.7 years among the commercial DMD cohort. Median monthly resource use was generally higher among the Medicaid DMD cohort; nonetheless, median (IQR) monthly costs were similar at    ,735 (   67-   ,281) for the Medicaid DMD cohort vs    ,883 (   57-   ,796) for the commercial DMD cohort. CONCLUSIONS: The demographic characteristics and median direct medical costs were similar between patients with commercial vs Medicaid coverage, even though patients with Medicaid coverage had higher resource use. Despite challenges in definitively identifying DMD patients using claims data, these findings help characterize contemporary DMD populations in the United States and the related direct economic burden to the payer. Copyright©2021, Academy of Managed Care Pharmacy. All rights reserved.