OBJECTIVES: To document, categorize, and quantify real-world costs associated with administering multiple sclerosis (MS) disease-modifying drug (DMD) infusions using medical billing codes occurring on the same day as a DMD infusion.

METHODS: The IQVIA™ RWD Adjudicated Claims–US database was used to identify patients with a diagnosis of MS and ≥1 Healthcare Common Procedure Coding System (HCPCS) billed medical claims for natalizumab, alemtuzumab, or ocrelizumab from 1/1/2017–9/30/2018. Patients with National Drug Code billed claims for a study DMD were excluded. All medical billing codes (i.e., HCPCS, Current Procedural Terminology [CPT] and Revenue) occurring on the same day as a HCPCS-coded claim for natalizumab, alemtuzumab, or ocrelizumab were included. CPT and HCPCS, and Revenue codes were categorized as administration, co-administration (e.g., pre-treatment steroid, antihistamine, pregnancy test, lab tests, etc.), MS-related, potentially MS-related, and not MS-related. The primary outcome was the average non-DMD cost per infusion-day (i.e., per dose) by category and DMD. The unit of analysis was the infusion-day.

RESULTS: The 8,812 patients meeting eligibility criteria had 63,389 infusion days. Mean total non-DMD costs for all medical codes billed on infusion-day were $936 for alemtuzumab, $830 for ocrelizumab, and $401 for natalizumab. Most non-DMD costs were categorized as administration costs; costs for administration per infusion-day were $827 for alemtuzumab, $750 for ocrelizumab, and $346 for natalizumab. The next most costly categories were co-administration costs (alemtuzumab $78, ocrelizumab $52, and natalizumab $18 per infusion-day), MS-related costs (alemtuzumab $5, ocrelizumab $18, and natalizumab $25 per infusion-day), potentially MS-related costs (alemtuzumab $18, ocrelizumab $4, and natalizumab $4 per infusion-day), and unrelated costs (alemtuzumab $9, ocrelizumab $5, and natalizumab $6 per infusion-day).

CONCLUSIONS: The ‘real-world’ costs of administering DMD infusions among patients with MS should be considered. Challenges exist in setting rules for specificity and sensitivity (e.g., time frame, code categorization, etc.) for capturing appropriate costs.