Impact of the COVID-19 pandemic on healthcare utilisation in US people living with multiple sclerosis: An analysis of the FlywheelMS cohort

ABSTRACT

Introduction: On 11 March 2020, the World Health Organization declared COVID-19 a pandemic. The effects of the pandemic on healthcare are still being described. Understanding these effects is especially important for people living with multiple sclerosis (PLwMS), who may have higher COVID-19 risks due to the use of immunosuppressive therapies and concomitant disability. Aims: To describe the impact of the COVID-19 pandemic on healthcare for PLwMS in the US. Methods: Adults with MS were recruited to the FlywheelMS study from across the US. Supervised machine learning with human curation was used to retrieve, digitise and abstract medical records, which were collected as far back as available. We compared healthcare interactions, assessments and disease-modifying therapies (DMTs) in the 6 months before and after 11 March 2020, from a constant cohort of patients. Results: Among the eligible cohort (N=1,485), total healthcare interactions were down 16.1% [15.3-17.0], (n=7,612, p<0.001) during the pandemic, a trend fuelled by declines in neurology (-19.5% [17.5-21.5], n=1,598, p<0.001) and physical therapy (-15.5% [11.6-19.4], n=384, p=0.002) visits. Telehealth interactions increased (+10.3% [1.4-17.3], n=68, p=0.02) though few interactions were conducted this way. The frequency of clinical and imaging assessments such as MRI (-43.7% [40.9-46.5], n=281, p<0.001), Expanded Disability Status Scale (-37.7% [29.1-46.2], n=146, p<0.001) and Timed 25-Foot Walk Test (-58.2% [52.1-64.3], n=280, p<0.001) declined substantially during the pandemic. DMT initiations also decreased markedly, with declines of at least 50% across platform (-50% [23.1-76.9], n=20, p=0.001), oral (-56.6% [44.1-69.0], n=76, p<0.001) and infusion (-58.4% [47.1-69.8], n=89, p<0.001) therapies. Finally, health record capture of mild relapses (those not requiring hospitalisation) was down 24.2% [17.7-30.8] in the pandemic period (n=194, p<0.001), while capture of severe relapses requiring hospitalisation remained constant (-3.3% [-8.1-1.5], n=91, p=0.75). Conclusions: Healthcare interactions, assessments and DMT initiations all declined for PLwMS in the US during the COVID-19 pandemic. Additionally, healthcare record capture for mild relapses, but not severe relapses, declined. These findings suggest patients and providers are deferring MS healthcare during the pandemic.