The impact of national policies on reimbursement of disease-modifying therapies for multiple sclerosis on disease outcomes: Slovenia versus Croatia.

OBJECTIVES

To assess how national policies on reimbursement for disease-modifying therapies (DMT) for multiple sclerosis (MS) affect disease outcomes.

METHODS

The study included consecutive Slovenian and Croatian people with MS (pwMS) from the MSBase registry. We calculated the following DMT variables: time to first DMT, total DMT duration, and whether DMT was ever used. We used 1:1 propensity score matching to pair pwMS from Slovenia and Croatia to reduce baseline differences between the groups.

RESULTS

Out of 894 pwMS from Slovenia and 1363 from Croatia, 565 pwMS from both countries were enrolled after propensity score matching. pwMS living in Croatia had significantly higher disability levels measured by EDSS compared to those living in Slovenia (2.0 vs 1.5, respectively; p = 0.004). The time to first-ever DMT was longer in the Croatian cohort (2.76; 1.20-6.92) than in the Slovenian cohort (1.29; 0.48-4.60), p < 0.001. In a multivariable logistic regression, pwMS residing in Croatia had a 52.8 % higher probability of EDSS ≥3 (Exp(B) 1.528; 95 % CI 1.182-1.974; p = 0.001). Additionally, the time to first-ever DMT increased the likelihood of EDSS ≥3 by 10.6 % (Exp(B) 1.106; 95 % CI 1.083-1.129; p < 0.001).

CONCLUSION

This study demonstrates that national policies on DMT reimbursement influence disability outcomes in pwMS. Those living in countries with less restrictive reimbursement policies are more likely to have lower disability levels.