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Differentiating societal costs of disability worsening in multiple sclerosis

Nils-Henning Ness1, Dirk Schriefer1, Rocco Haase1

  • 1MS Center, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany.

Journal of Neurology
|December 19, 2019
PubMed
Abstract

Insights

Progression independent of relapse activity (PIRA) and relapse-associated worsening (RAW) in multiple sclerosis (MS) significantly increase societal economic costs. Delaying or preventing MS progression could reduce the economic burden on society.

Area of Science:

  • Neurology
  • Health Economics
  • Public Health

Background:

  • Multiple sclerosis (MS) is characterized by confirmed disability progression (CDP), which can stem from progression independent of relapse activity (PIRA) or relapse-associated worsening (RAW).
  • The economic impact of PIRA and RAW on the overall societal costs for MS patients remains insufficiently understood.
  • Understanding these economic drivers is crucial for resource allocation and healthcare policy development in MS management.

Purpose of the Study:

  • To quantify and compare the societal economic costs associated with disease activity-free status (DAF) versus PIRA and RAW events in patients with MS.
  • To elucidate the specific economic contributions of different disease progression pathways to the total burden of MS.
  • To provide data that can inform strategies aimed at mitigating the economic impact of MS.

Main Methods:

  • A roving Expanded Disability Status Scale (EDSS) score analysis was employed to identify PIRA and RAW events, requiring confirmation after a minimum of 6 months.
  • Age-, gender-, and EDSS-adjusted analyses were conducted to estimate the effects of PIRA and RAW on total, direct medical, direct non-medical, and indirect societal economic costs.
  • Patients achieving DAF were used as the reference group for cost comparisons.

Main Results:

  • The study analyzed 1959 patients, revealing mean quarterly societal economic costs of 6929€ (including disease-modifying therapies [DMTs]) over 2 years.
  • Excluding DMTs, patients in DAF status incurred mean quarterly costs of 1703€.
  • PIRA led to a 29% increase in total costs (IRR: 1.29) compared to DAF, while RAW increased costs by 56% (IRR: 1.56). Direct medical costs saw substantial increases with PIRA (1.48-fold) and RAW (2.25-fold).

Conclusions:

  • Both PIRA and RAW significantly elevate the societal economic costs associated with multiple sclerosis.
  • The findings underscore the economic imperative of managing and potentially preventing disease progression in MS.
  • Interventions aimed at delaying or preventing disease progression in MS are likely to yield substantial reductions in the overall societal economic burden.
Keywords:
Cost of illnessMultiple sclerosisProgressionResource utilizationWorsening

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