Economic and social burden of multiple sclerosis in Morocco: a tertiary care center study

Multiple sclerosis (MS) imposes substantial clinical, economic, and social consequences, particularly in young adults during their most productive years. While the societal cost of MS has been extensively studied in high-income countries, data from low- and middle-income countries remain scarce. We aimed to provide the first comprehensive societal cost-of-illness analysis of MS in Morocco.

We conducted a single-center, cross-sectional study including 100 adults with MS followed at a tertiary university hospital in Casablanca. Costs were assessed from a societal perspective and annualized at the individual level, including direct medical, direct non medical, and indirect costs (human capital approach). Disability was measured using the Expanded Disability Status Scale (EDSS). Health-related quality of life was evaluated using the EQ-5D-5L Moroccan value set to derive utility scores.

The mean age was 37.9 years, and 71.0% were women. Median EDSS was 2.0 (IQR: 1.0-6.0; range: 0-10). The mean annual total cost per patient was 92,646 MAD (≈9,358 USD). Direct medical costs averaged 58,884 MAD (5,948 USD), predominantly driven by disease-modifying therapies (47,759 MAD). Direct non medical costs were modest (984 MAD). Indirect costs averaged 32,777 MAD (3,311 USD), largely reflecting productivity losses and informal caregiving. Cost distribution shifted with disability severity: direct medical costs predominated at lower EDSS levels, whereas indirect costs became the principal contributor with increasing disability. The mean EQ-5D-5L utility score was 0.688.

MS in Morocco generates a substantial societal burden that extends far beyond medical expenditures. While early stage disease is mainly associated with pharmacological costs, advancing disability shifts the burden toward productivity loss and informal care. These findings underscore the necessity of context-specific pharmacoeconomic frameworks and policies that integrate clinical severity, social vulnerability, and healthcare system constraints in low and middle-income settings.