Profile of Medical Care Costs in Patients with Amyotrophic Lateral Sclerosis in Medicare Program and under Commercial Insurance (P7.102)

OBJECTIVE: The primary objective of this analysis was to characterize the medical care costs incurred for ALS patients covered by Medicare and commercial insurance. BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a rare disease causing progressive denervation and consequent skeletal muscle atrophy leading to weakness, fatigue, muscle weakness and death, primarily from respiratory complications. Treatment consists of modest alteration of disease progression, symptom alleviation, and supportive measures. METHODS: 368 ALS patients who were diagnosed between January 1, 2009 and December 31, 2010 were identified from a 5% sample of Medicare claims (2008-2011). 344 ALS patients who were diagnosed using the same methodology as the Medicare cases were also selected from the Truven Marketscan commercial database (2008-2010). The monthly claim costs were tabulated from one year before the index date until death or the end of 2011 for Medicare cases. An exponential regression was used to model the monthly cost prior to index date. Kaplan-Meier Sample Average was employed to model the lifetime cost since index date, adjusting for censored cases. Medical costs from index date to disability milestones were tabulated from the Medicare database. RESULTS: Both Medicare program and commercial insurance demonstrate comparable monthly cost patterns before diagnosis. The cost increased exponentially before diagnosis. The monthly claim cost dropped sharply after the diagnosis month and then increased steadily until death. ALS patients initially covered under commercial insurance and then switched to Medicare coverage had comparable patterns to patients in pure Medicare programs. Patients in pure Medicare program had increasing total cost along with worsening disability milestones. DISCUSSIONS: The detailed monthly cost patterns from both programs as well as the transition from commercial insurance to Medicare program will be further studied. These results will be used to guide rigorous estimation of the economic burden associated with disability milestones in ALS medical care. Disclosure: Dr. Meng has received personal compensation for activities with Cytokinetics, Inc. as an employee. Dr. Jordan has received personal compensation for activities with Cytokinetics, Inc. as an employee. Dr. Bian has received personal compensation for activities with Cytokinetics, Inc. as an employee. Dr. Andrews has received personal compensation for activities with Cytokinetics, Inc. as an employee. Dr. Andrews has received research support from Cytokinetics, Inc., and Biogen Idec. Dr. Wolff has received personal compensation for activities with Cytokinetics, Inc. as an employee. Dr. Wolff holds stock and/or stock options in Cytokinetics, Inc. which sponsored research in which Dr. Wolff was involved as an investigator. Dr. Wolff has received research support from Cytokinetics, Inc. Dr. Blumen has received personal compensation for activities with Milliman, Inc. as an employee, and Cytokinetics. Dr. Blumen has received research support from Milliman, Inc. Dr. Iwasaki has received personal compensation for activities with Milliman, Inc. as an employee, and Cytokinetics. Dr. Iwasaki has received research support from Milliman Inc. Dr. Pyenson has received personal compensation for activities with Milliman Inc., which received funding from Cytokinetics.