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Multiple Sclerosis Disease-Modifying Therapy Prescribing Patterns in Ontario

Published online by Cambridge University Press:  23 September 2014

James J. Marriott ,
Muhammad Mamdani ,
Gustavo Saposnik ,
Tara Gomes ,
Michael Manno  and
Paul W. O'Connor
James J. Marriott
Affiliation:
Department of Internal Medicine (Neurology), University of Manitoba, Winnipeg, Manitoba
Muhammad Mamdani
Affiliation:
Department of Health Policy, Management, and Evaluation, Toronto, Canada Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, St. Michael's Hospital, Toronto, Canada
Gustavo Saposnik
Affiliation:
Department of Health Policy, Management, and Evaluation, Toronto, Canada Department of Medicine (Neurology), University of Toronto, Toronto, Canada Institute of Clinical Evaluative Sciences, Mobility Program, St. Michael's Hospital, Toronto, Canada Stroke Research Unit, Mobility Program Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, St. Michael's Hospital, Toronto, Canada
Tara Gomes
Affiliation:
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada Institute of Clinical Evaluative Sciences, Mobility Program, St. Michael's Hospital, Toronto, Canada Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, St. Michael's Hospital, Toronto, Canada
Michael Manno
Affiliation:
Ontario HIV Treatment Network, Toronto, Canada
Paul W. O'Connor*
Affiliation:
Multiple Sclerosis Clinic and MS Research and Evoked Potentials Laboratory, St. Michael's Hospital, Toronto, Canada Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, St. Michael's Hospital, Toronto, Canada
*
Section of Neurology, Health Sciences Centre, GF543-820Sherbrook Street, Winnipeg, Manitoba, R3a 1R9, Canada Email: jmarriott@hsc.mb.ca
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Abstract:

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Background:

Differences in Multiple sclerosis (MS) disease-modifying therapy (DMT) prescribing patterns between different groups of neurologists have not been explored.

Objective:

To examine concentrations of prescribing patterns and to assess if MS-specialists use a broader range of DMTs relative to general neurologists.

Methods:

We conducted a cross-sectional study using administrative claims databases in Ontario, Canada to link neurologists to 2009 DMT prescription data. MS specialization was defined using both practice location and prescription patterns. Lorenz curves and Gini coefficients were constructed to examine prescribing patterns, separating neurologist characteristics dichotomously and separating Avonex from the other standard DMTs (Betaseron, Rebif and Copaxone). Gini coefficient 95% confidence intervals (CIs) were derived using jack-knife statistical techniques.

Results:

Prescriptions were highly concentrated with 12% of Ontario neurologists prescribing 80% of DMTs. There was a trend towards Avonex being more commonly prescribed relative to the other DMTs. When MS specialization was defined by DMT prescribing, high-volume prescribing neurologists showed a broader range of DMT prescribing (Gini 0.38-0.44) in comparison to low-volume prescribers (Gini 0.57-0.66).

Conclusions:

The majority of DMTs are prescribed by a small subset of neurologists. High-volume prescribing MS-specialists show more variability in DMT use while low-volume prescribers tend to individually focus on a narrower range of DMTs.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 1 , January 2013 , pp. 67 - 72
Copyright
Copyright © The Canadian Journal of Neurological 2013

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