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Ahmad H, Campbell JA, van der Mei I, Taylor BV, Xia Q, Zhao T, Palmer AJ. Estimating the disutility of relapse in relapsing-remitting and secondary progressive multiple sclerosis using the EQ-5D-5L, AQoL-8D, EQ-5D-5L-psychosocial, and SF-6D: implications for health economic evaluation models. Qual Life Res 2023; 32:3373-3387. [PMID: 37522942 PMCID: PMC10624739 DOI: 10.1007/s11136-023-03486-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND AND AIMS Relapses are an important clinical feature of multiple sclerosis (MS) that result in temporary negative changes in quality of life (QoL), measured by health state utilities (HSUs) (disutilities). We aimed to quantify disutilities of relapse in relapsing remitting MS (RRMS), secondary progressive MS (SPMS), and relapse onset MS [ROMS (including both RRMS and SPMS)] and examine these values by disability severity using four multi-attribute utility instruments (MAUIs). METHODS We estimated (crude and adjusted and stratified by disability severity) disutilities (representing the mean difference in HSUs of 'relapse' and 'no relapse' groups as well as 'unsure' and 'no relapse' groups) in RRMS (n = 1056), SPMS (n = 239), and ROMS (n = 1295) cohorts from the Australian MS Longitudinal Study's 2020 QoL survey, using the EQ-5D-5L, AQoL-8D, EQ-5D-5L-Psychosocial, and SF-6D MAUIs. RESULTS Adjusted mean overall disutilities of relapse in RMSS/SPMS/ROMS were - 0.101/- 0.149/- 0.129 (EQ-5D-5L), - 0.092/- 0.167/- 0.113 (AQoL-8D), - 0.080/- 0.139/- 0.097 (EQ-5D-5L-Psychosocial), and - 0.116/- 0.161/- 0.130 (SF-6D), approximately 1.5 times higher in SPMS than in RRMS, in all MAUI. All estimates were statistically significant and/or clinically meaningful. Adjusted disutilities of RRMS and ROMS demonstrated a U-shaped relationship between relapse disutilities and disability severity. Relapse disutilities were higher in 'severe' disability than 'mild' and 'moderate' in the SPMS cohort. CONCLUSION MS-related relapses are associated with substantial utility decrements. As the type and severity of MS influence disutility of relapse, the use of disability severity and MS-type-specific disutility inputs is recommended in future health economic evaluations of MS. Our study supports relapse management and prevention as major mechanisms to improve QoL in people with MS.
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Affiliation(s)
- Hasnat Ahmad
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
- Australian Government Department of Health and Aged Care, Canberra, Australia.
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Qing Xia
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ting Zhao
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Vitturi BK, Rahmani A, Dini G, Montecucco A, Debarbieri N, Bandiera P, Battaglia MA, Manacorda T, Persechino B, Buresti G, Ponzio M, Inglese M, Durando P. Spatial and temporal distribution of the prevalence of unemployment and early retirement in people with multiple sclerosis: A systematic review with meta-analysis. PLoS One 2022; 17:e0272156. [PMID: 35901070 PMCID: PMC9333213 DOI: 10.1371/journal.pone.0272156] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background We aimed to summarise the prevalence of unemployment and early retirement among people with MS and analyze data according to a spatio-temporal perspective. Methods We undertook a systematic search of PubMed/MEDLINE, Scopus, SciVerse ScienceDirect, and Web of Science. We included any peer-reviewed original article reporting the prevalence of unemployment and early retirement in the working-age population with MS. We excluded articles off-topic, with other study designs, whose study sample were unlikely to be representative of the MS population and in case of unavailability of the full text or essential information. A random-effects meta-analysis was used to measure overall prevalence estimates of unemployment and early retirement. We used meta-regression and subgroup analysis to evaluate potential moderators of prevalence estimates and the leave-one-out method for sensitivity analyses. Results Our research identified 153 studies across 29 countries encompassing 188436 subjects with MS. The pooled overall effect size for unemployment and early retirement was 35.6% (95% CI 32.8–38.4; I2 = 99.31) and 17.2% (95% CI 14.6–20.2; I2 = 99.13), respectively. The prevalence of unemployment varied according to the year of publication (p < 0.001) and there was a statistically significant decrease in the prevalence of unemployment over time (p = 0.042). Regarding early retirement, only seven (31.8%) estimates obtained from studies that were published before 2010 were below the overall effect size in comparison to 27 (60.0%) estimates extracted from data published between 2010 and 2021 (p = 0.039). There was a significant difference in prevalence according to countries (p < 0.001). Psychiatric illness was an important clinical feature responsible for patients leaving the workforce in regions with a high MS prevalence. Conclusions Unemployment and early retirement due to MS remain highly prevalent, despite a slight decline in the last decade. The prevalence of unemployment and early retirement varies globally.
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Affiliation(s)
| | - Alborz Rahmani
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Alfredo Montecucco
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Nicoletta Debarbieri
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Paolo Bandiera
- Italian Multiple Sclerosis Association (AISM), Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- Department of Life Science, University of Siena, Siena, Italy
| | - Tommaso Manacorda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | | | | | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
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Rezaee M, Keshavarz K, Izadi S, Jafari A, Ravangard R. Economic burden of multiple sclerosis: a cross-sectional study in Iran. HEALTH ECONOMICS REVIEW 2022; 12:2. [PMID: 34981265 PMCID: PMC8725304 DOI: 10.1186/s13561-021-00350-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic debilitating disease that imposes a heavy socioeconomic burden on societies. This study aimed to determine the economic burden of MS on patients using the first (CinnoVex and ReciGen) and second (Fingolimod and Natalizumab) drug therapy lines. METHODS This cost of illness study was an economic evaluation carried out as cross-sectional research in 2019 in southern Iran. A total of 259 patients were enrolled in two lines of drug therapy (178 patients in the first line and 81 ones in the second). The prevalence-based approach and the bottom-up approach were used to collect cost information and to calculate the costs from the societal perspective, respectively. The human capital approach was applied to calculate indirect costs. To collect the required data a researcher-made data collection form was utilized. The data were obtained using the information available in the patients' medical records and insurance invoices as well as their self-reports or that of their companions. RESULTS The results showed that the annual costs of MS in the first and second lines of drug therapy per patient were $ 1919 and $ 4082 purchasing power parity (PPP), respectively, and in total, $ 2721 PPP in 2019. The highest mean costs in both lines were those of direct medical costs, of which purchasing the main medicines in both lines accounted for the highest. CONCLUSION Considering the findings of this study and in order to reduce the burden of the disease, the following suggestions are presented: providing necessary facilities for the production of MS drugs in the country; proper and equitable distribution of neurologists; expanding the provision of home care services; and using the technologies related to the Internet, including WhatsApp, to follow up the MS patients' treatment.
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Affiliation(s)
- Mehdi Rezaee
- Student Research Committee, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Khosro Keshavarz
- Department of Health Services Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Almas Building, Alley 29, Qasrodasht Avenue, 71336-54361 Shiraz, Iran
| | - Sadegh Izadi
- Clinical Neurology Research Center, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdosaleh Jafari
- Department of Health Services Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Almas Building, Alley 29, Qasrodasht Avenue, 71336-54361 Shiraz, Iran
| | - Ramin Ravangard
- Department of Health Services Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Almas Building, Alley 29, Qasrodasht Avenue, 71336-54361 Shiraz, Iran
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Schriefer D, Haase R, Ness NH, Ziemssen T. Cost of illness in multiple sclerosis by disease characteristics - A review of reviews. Expert Rev Pharmacoecon Outcomes Res 2021; 22:177-195. [PMID: 34582300 DOI: 10.1080/14737167.2022.1987218] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: In light of the increasing number of economic burden studies and heterogeneity in methodology and reporting standards, there is a need for robust evidence synthesis on an umbrella review level.Areas covered: We performed the first review of reviews of cost-of-illness studies in multiple sclerosis. Focusing on disaggregated costs by disease characteristics (disability level, relapse, disease course), we also characterized the underlying methodological evidence base of individual (primary) studies.Expert Commentary: We identified 17 reviews encompassing 111 unique primary studies, and a high degree of overlap across reviews. Costs were substantial, rising with disability level, relapse episodes, and disease progression. Disability was the key cost driver. Compared to mild disability, total costs for moderate disability were 1.4-2.3-fold higher and 1.8-2.9-fold higher for severe disability. With escalating disability, the share of costs outside the health system (indirect costs, informal care) increasingly outweighed the share of direct medical costs. Of all 111 primary studies, 72% gathered resource use/loss data by patient self-report. Associated costs were mostly reported by disability level (75%), followed by relapse (48%) and disease course (21%). In conclusion, although heterogeneity can make in-depth comparisons of costs across studies impossible, important patterns are broadly apparent.
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Affiliation(s)
- Dirk Schriefer
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Rocco Haase
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
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Kremer IEH, Hiligsmann M, Carlson J, Zimmermann M, Jongen PJ, Evers SMAA, Petersohn S, Pouwels XGLV, Bansback N. Exploring the Cost Effectiveness of Shared Decision Making for Choosing between Disease-Modifying Drugs for Relapsing-Remitting Multiple Sclerosis in the Netherlands: A State Transition Model. Med Decis Making 2021; 40:1003-1019. [PMID: 33174513 PMCID: PMC7672783 DOI: 10.1177/0272989x20961091] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Up to 31% of patients with relapsing-remitting multiple sclerosis (RRMS) discontinue treatment with disease-modifying drug (DMD) within the first year, and of the patients who do continue, about 40% are nonadherent. Shared decision making may decrease nonadherence and discontinuation rates, but evidence in the context of RRMS is limited. Shared decision making may, however, come at additional costs. This study aimed to explore the potential cost-effectiveness of shared decision making for RRMS in comparison with usual care, from a (limited) societal perspective over a lifetime. Methods An exploratory economic evaluation was conducted by adapting a previously developed state transition model that evaluates the cost-effectiveness of a range of DMDs for RRMS in comparison with the best supportive care. Three potential effects of shared decision making were explored: 1) a change in the initial DMD chosen, 2) a decrease in the patient’s discontinuation in using the DMD, and 3) an increase in adherence to the DMD. One-way and probabilistic sensitivity analyses of a scenario that combined the 3 effects were conducted. Results Each effect separately and the 3 effects combined resulted in higher quality-adjusted life years (QALYs) and costs due to the increased utilization of DMD. A decrease in discontinuation of DMDs influenced the incremental cost-effectiveness ratio (ICER) most. The combined scenario resulted in an ICER of €17,875 per QALY gained. The ICER was sensitive to changes in several parameters. Conclusion This study suggests that shared decision making for DMDs could potentially be cost-effective, especially if shared decision making would help to decrease treatment discontinuation. Our results, however, may depend on the assumed effects on treatment choice, persistence, and adherence, which are actually largely unknown.
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Affiliation(s)
- Ingrid E H Kremer
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Josh Carlson
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | | | - Peter J Jongen
- MS4 Research Institute, Nijmegen, The Netherlands.,Department of Community and Occupational Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands.,Centre for Economic Evaluations, Trimbos Institute, Utrecht, The Netherlands
| | - Svenja Petersohn
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands.,Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Xavier G L V Pouwels
- Department of Health Technology & Services Research, Faculty of Behavioral, Management & Social Sciences, University of Twente, Enschede, The Netherlands
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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6
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The increasing economic burden of multiple sclerosis by disability severity in Australia in 2017: Results from updated and detailed data on types of costs. Mult Scler Relat Disord 2020; 44:102247. [DOI: 10.1016/j.msard.2020.102247] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/08/2020] [Accepted: 05/27/2020] [Indexed: 11/19/2022]
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7
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Michels RE, de Fransesco M, Mahajan K, Hengstman GJD, Schiffers KMH, Budhia S, Harty G, Krol M. Cost Effectiveness of Cladribine Tablets for the Treatment of Relapsing-Remitting Multiple Sclerosis in The Netherlands. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:857-873. [PMID: 31444659 PMCID: PMC6885501 DOI: 10.1007/s40258-019-00500-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cladribine tablets have recently become available in The Netherlands for patients with relapsing-remitting multiple sclerosis (RRMS) as a disease-modifying agent that reduces the frequency and severity of relapses and delays disability progression. OBJECTIVE The aim of this study was to evaluate the cost effectiveness of cladribine tablets, compared with alternative options, in the treatment of RRMS patients with high disease activity (HDA) and patients with rapidly evolving severe (RES) MS in The Netherlands. METHODS A Markov model was developed simulating the costs and effects of RRMS treatment. For HDA, alemtuzumab and fingolimod were used as comparators; natalizumab was used for the RES subpopulation. The analysis included a societal perspective and a value-of-information (VOI) analysis. RESULTS For the HDA subpopulation, treatment with cladribine tablets was the cost-effective (dominant) strategy compared with alemtuzumab and fingolimod, with 50.9% and 98.2%, respectively, probability of being cost effective at a threshold of €50,000/QALY gained and a net monetary benefit (NMB) of €10,866 and €151,115, respectively. For the RES subpopulation, treatment with cladribine tablets dominated treatment with natalizumab, with 94.1% probability of being cost effective at a threshold of €50,000/QALY gained and an NMB of €122,986. Note that these outcomes are driven by the lower costs of cladribine tablets. Efficacy differences were small, very uncertain, and likely not clinically meaningful. The probabilistic sensitivity analyses showed significant overlap in the credible intervals for total lifetime QALY outcomes and costs of cladribine tablets and all relevant comparators. The population-level VOI amounted to €19,295,441. CONCLUSIONS The base-case analysis shows that treatment of RRMS with cladribine tablets is cost effective versus alemtuzumab and fingolimod in HDA patients, and cost effective versus natalizumab in RES patients, at a threshold of €50,000. Driven by the lower costs, cladribine tablets were cost effective (dominant) in all base-case analyses. However, given that outcomes are based on indirect comparisons and post hoc subgroup analysis, as well as the uncertainty surrounding the outcomes, the results presented in this paper should be interpreted with caution.
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Affiliation(s)
- Renée Else Michels
- IQVIA, Real World Evidence Solutions, Herikerbergweg 314, 1101 CT, Amsterdam, The Netherlands
| | | | | | - Gerald J D Hengstman
- Department of Neurology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | | | - Sangeeta Budhia
- PAREXEL International, PAREXEL Access Consulting, London, UK
| | - Gerard Harty
- EMD Serono, a business of Merck KGaA, Boston, MA, USA
| | - Marieke Krol
- IQVIA, Real World Evidence Solutions, Herikerbergweg 314, 1101 CT, Amsterdam, The Netherlands.
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van Egmond E, van Gorp D, Honan C, Heerings M, Jongen P, van der Klink J, Reneman M, Beenakker E, Frequin S, de Gans K, Hengstman G, Hoitsma E, Mostert J, Verhagen W, Zemel D, Middelkoop H, Visser L, van der Hiele K. A Dutch validation study of the Multiple Sclerosis Work Difficulties Questionnaire in relapsing remitting multiple sclerosis. Disabil Rehabil 2019; 43:1924-1933. [PMID: 31702954 DOI: 10.1080/09638288.2019.1686072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The current study aimed to evaluate the psychometric properties of the Dutch version of the Multiple Sclerosis Work Difficulties Questionnaire-23 (MSWDQ-23). METHODS Two hundred and thirty-nine employed persons with multiple sclerosis (MS) and 59 healthy controls completed the MSWDQ-23. To verify the factor structure, a confirmatory factor analysis was conducted. To assess construct validity, the MSWDQ-23 scores were correlated to measures of physical disability, fatigue, cognitive and neuropsychiatric problems, depression, health-related quality of life, and work-related variables. MSWDQ-23 scores were compared within different age groups, gender, education levels, and job types. Predictive validity was assessed using a logistic regression analysis to predict a deterioration in employment status after one year based on MSWDQ-23 scores. RESULTS The internal consistency of the MSWDQ-23 was acceptable (α = 0.913, 95% CI = 0.897-0.928) and the results indicated a fair fit. The MSWDQ-23 showed acceptable construct validity, confirming 94% of the hypotheses. The total scale and the psychological/cognitive subscale were able to predict a deterioration in employment status after one year (χ2(1)=18.164, p < 0.001). CONCLUSIONS The Dutch version of the MSWDQ-23 is a valid and internally consistent instrument to measure self-reported work difficulties in persons with MS.Implications for rehabilitationThe Dutch version of the 23-item Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ-23) is a reliable and valid tool to measure self-reported work difficulties in people with multiple sclerosis (MS).More psychological and cognitive work difficulties are predictive of a deteriorated employment status after one year.The MSWDQ-23 is a helpful tool for researchers and (occupational) health professionals to identify current work difficulties in persons with MS and identify persons at risk for a deterioration in employment one year later.
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Affiliation(s)
- Elianne van Egmond
- National Multiple Sclerosis Foundation, Rotterdam, The Netherlands.,Department of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.,Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Dennis van Gorp
- National Multiple Sclerosis Foundation, Rotterdam, The Netherlands.,Department of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.,Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.,Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Cynthia Honan
- Discipline of Psychology, School of Medicine, University of Tasmania, Tasmania, Australia
| | - Marco Heerings
- National Multiple Sclerosis Foundation, Rotterdam, The Netherlands
| | - Peter Jongen
- MS4 Research Institute, Nijmegen, The Netherlands.,Department of Community and Occupational Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jac van der Klink
- Department of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Michiel Reneman
- Department of Rehabilitation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Ernesto Beenakker
- Department of Neurology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Stephan Frequin
- Department of Neurology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Koen de Gans
- Department of Neurology, Groene Hart Hospital, Gouda, The Netherlands
| | - Gerald Hengstman
- Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands
| | - Elske Hoitsma
- Department of Neurology, Alrijne Hospital Leiden, Leiden, The Netherlands
| | - Jop Mostert
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Wim Verhagen
- Department of Neurology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Désirée Zemel
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Huub Middelkoop
- Department of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.,Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Leo Visser
- Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.,Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Karin van der Hiele
- National Multiple Sclerosis Foundation, Rotterdam, The Netherlands.,Department of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.,Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
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9
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Hategeka C, Traboulsee AL, McMullen K, Lynd LD. Association of Unemployment and Informal Care with Stigma in Multiple Sclerosis: Evidence from the Survey on Living with Neurological Conditions in Canada. Int J MS Care 2019; 21:214-225. [PMID: 31680783 DOI: 10.7224/1537-2073.2017-108] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Multiple sclerosis (MS) typically affects young adults during their primary productive years. We assessed the magnitude of, and factors associated with, employment status and informal care in people with MS in Canada. Methods Data were compiled from the nationally representative cross-sectional Survey on Living with Neurological Conditions in Canada (SLNCC), which included adolescents and adults (age ≥15 years). Employment status was categorized as currently working or not working. The frequency of informal care that people with MS received was categorized as none, less than daily, or daily. Logistic regression analyses were undertaken to identify factors associated with employment status and informal care requirements in people with MS. Results Of 4409 SLNCC respondents, 631 had MS, of whom 530 were included in the analysis. Of 358 respondents aged 18 to 65 years, 47.8% were not working because of MS; 44.0% reported receiving informal care, with more than half requiring daily care. For caregivers' employment, 15.5% reduced work and 8.2% stopped working because of caregiving. Greater feelings of stigmatization were associated with not working (adjusted odds ratio, 7.42 [95% CI, 2.59-21.28]) and greater informal care (adjusted odds ratio, 3.83 [95% CI, 1.84-7.96]), adjusting for sex, age, education, health-related quality of life, time since MS diagnosis, and comorbidity. Conclusions People who feel stigmatized because of their MS are more likely to be unemployed and to require more informal care. Further research is needed to understand the temporal nature of the association between stigma and employment, productivity loss, and informal care.
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Cognitive functioning as a predictor of employment status in relapsing-remitting multiple sclerosis: a 2-year longitudinal study. Neurol Sci 2019; 40:2555-2564. [PMID: 31321625 PMCID: PMC6848242 DOI: 10.1007/s10072-019-03999-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/27/2019] [Indexed: 01/10/2023]
Abstract
Background Cognitive functioning has been linked to employment outcomes in multiple sclerosis (MS) in cross-sectional studies. Longitudinal studies are however lacking and previous studies did not extensively examine executive functioning. Objectives We examined whether baseline cognitive functioning predicts a change in employment status after 2 years, while taking into account mood, fatigue and disability level. Methods A total of 124 patients with relapsing-remitting MS (pwMS) and 60 healthy controls were included. They underwent neurological and neuropsychological examinations and completed online questionnaires. PwMS were divided into a stable and deteriorated employment status group (SES and DES), based on employment status 2 years after baseline. We first examined baseline differences between the SES and DES groups in cognitive functioning, mood, fatigue and disability level. A logistic regression analysis was performed, with change in employment status (SES/DES) as dependent variable. Results The DES group included 22% pwMS. Group differences were found in complex attention, executive functioning, self-reported cognitive functioning, fatigue and physical disability. More physical disability (OR = 1.90, p = 0.01) and lower executive functioning (OR = 0.30, p = 0.03) were retained as independent predictors of DES (R2 = 0.22, p ≤ 0.001). Conclusions Baseline physical disability and executive functioning, but none of the other variables, moderately predicted a deterioration in employment status 2 years later. Trial registration This observational study is registered under NL43098.008.12: ‘Voorspellers van arbeidsparticipatie bij mensen met relapsing-remitting Multiple Sclerose’. This study is registered at the Dutch CCMO register (https://www.toetsingonline.nl). Electronic supplementary material The online version of this article (10.1007/s10072-019-03999-w) contains supplementary material, which is available to authorized users.
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Eriksson J, Kobelt G, Gannedahl M, Berg J. Association between Disability, Cognition, Fatigue, EQ-5D-3L Domains, and Utilities Estimated with Different Western European Value Sets in Patients with Multiple Sclerosis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:231-238. [PMID: 30711069 DOI: 10.1016/j.jval.2018.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 04/27/2018] [Accepted: 08/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To assess the association between fatigue, cognition, domains of the EuroQol five-dimensional questionnaire (EQ-5D-3L), disability, and utilities estimated with several Western European value sets in patients with multiple sclerosis (MS). METHODS Data from a multinational, cross-sectional, observational study of patients with MS (N = 16,808) conducted in 16 European countries were used. Health-related quality of life data were collected through the EQ-5D-3L, and fatigue and cognitive difficulties were self-assessed on a 10-point visual analogue scale. Associations were assessed using Pearson correlation and multivariate regression model. RESULTS Symptoms of fatigue and cognitive difficulties were present in 90% and 70% of patients at all levels of disability, respectively, and thus only weakly correlated to disability. Problems in the EQ-5D-3L domains were common even at mild disability levels. Mobility, usual activities, and pain issues were experienced by 80% to 90% of patients with moderate and high levels of disability. Mobility, usual activities, and self-care were strongly correlated to disability. Disability, MS type, fatigue, and cognition were associated with utility in regression models, although the coefficients of fatigue and cognition were small. CONCLUSIONS The strong relationship of disability with utility was confirmed. Despite this, fatigue and cognitive difficulties were associated with utility estimated with different European value sets.
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Pike J, Grosse SD. Friction Cost Estimates of Productivity Costs in Cost-of-Illness Studies in Comparison with Human Capital Estimates: A Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:765-778. [PMID: 30094591 PMCID: PMC6467569 DOI: 10.1007/s40258-018-0416-4] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Cost-of-illness (COI) studies often include the 'indirect' cost of lost production resulting from disease, disability, and premature death, which is an important component of the economic burden of chronic conditions assessed from the societal perspective. In most COI studies, productivity costs are estimated primarily as the economic value of production forgone associated with loss of paid employment (foregone gross earnings); some studies include the imputed value of lost unpaid work as well. This approach is commonly but imprecisely referred to as the human capital approach (HCA). However, there is a lack of consensus among health economists as to how to quantify loss of economic productivity. Some experts argue that the HCA overstates productivity losses and propose use of the friction cost approach (FCA) that estimates societal productivity loss as the short-term costs incurred by employers in replacing a lost worker. This review sought to identify COI studies published during 1995-2017 that used the FCA, with or without comparison to the HCA, and to compare FCA and HCA estimates from those studies that used both approaches. We identified 80 full COI studies (of which 75% focused on chronic conditions), roughly 5-8% of all COI studies. The majority of those studies came from three countries, Canada, Germany, and the Netherlands, that have officially endorsed use of the FCA. The FCA results in smaller productivity loss estimates than the HCA, although the differential varied widely across studies. Lack of standardization of HCA and FCA methods makes productivity cost estimates difficult to compare across studies.
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Affiliation(s)
- Jamison Pike
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, 1600 Clifton Road NE, MS A-19, Atlanta, GA, 30329-4027, USA.
| | - Scott D Grosse
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA
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13
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Piena MA, Heisen M, Wormhoudt LW, Wingerden JV, Frequin STFM, Uitdehaag BMJ. Cost-minimization analysis of alemtuzumab compared to fingolimod and natalizumab for the treatment of active relapsing-remitting multiple sclerosis in the Netherlands. J Med Econ 2018; 21:968-976. [PMID: 29911917 DOI: 10.1080/13696998.2018.1489255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AIM In active relapsing remitting multiple sclerosis (RRMS) patients requiring second-line treatment, the Dutch National Health Care Institute (ZiN) has not stated a preference for either alemtuzumab, fingolimod, or natalizumab. The aim was to give healthcare decision-makers insight into the differences in cost accumulation over time between alemtuzumab-with a unique, non-continuous treatment schedule-and fingolimod and natalizumab for second-line treatment of active RRMS patients in the Netherlands. METHODS In line with ZiN's assessment, a cost-minimization analysis was performed from a Dutch healthcare perspective over a 5-year time horizon. Resource use was derived from hospital protocols and summaries of product characteristics, and validated by two MS specialists. Unit costs were based on national tariffs and guidelines. Robustness of the base case results was verified with multiple sensitivity and scenario analyses. RESULTS Alemtuzumab results in cost savings compared to fingolimod and natalizumab from, respectively, 3.3 and 2.8 years since treatment initiation onwards. At 5 years, total discounted costs per patient of alemtuzumab were €79,717, followed by fingolimod with €110,044 and natalizumab with €122,238, resulting in cost savings of €30,327 and €42,522 for alemtuzumab compared to fingolimod and natalizumab, respectively. Key drivers of the model are drug acquisition costs and the proportions of patients that do not require further alemtuzumab treatment after either two, three, or four courses. LIMITATIONS No treatment discontinuation and associated switching between treatments were incorporated. Consequences of JC virus seropositivity while continuing natalizumab treatment (e.g. additional monitoring) were omitted from the base case. CONCLUSION The current cost-minimization analysis demonstrates that, from the Dutch healthcare perspective, treating active RRMS patients with alemtuzumab results in cost savings compared to second-line alternatives fingolimod and natalizumab from ∼3 years since treatment initiation onwards. After 5 years, alemtuzumab's cost savings are estimated at €30k compared to fingolimod and €43k compared to natalizumab.
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Affiliation(s)
- M A Piena
- a Pharmerit International , Rotterdam , The Netherlands
| | - M Heisen
- a Pharmerit International , Rotterdam , The Netherlands
| | - L W Wormhoudt
- b Sanofi Genzyme Netherlands , Naarden , The Netherlands
| | | | - S T F M Frequin
- c Department of Neurology , St. Antonius Ziekenhuis , Nieuwegein , The Netherlands
| | - B M J Uitdehaag
- d Department of Neurology , VU University Medical Center , Amsterdam , The Netherlands
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14
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van Gorp DAM, van der Klink JJL, Abma FI, Jongen PJ, van Lieshout I, Arnoldus EPJ, Beenakker EAC, Bos HM, van Eijk JJJ, Fermont J, Frequin STFM, de Gans K, Hengstman GJD, Hupperts RMM, Mostert JP, Pop PHM, Verhagen WIM, Zemel D, Heerings MAP, Reneman MF, Middelkoop HAM, Visser LH, van der Hiele K. The capability set for work - correlates of sustainable employability in workers with multiple sclerosis. Health Qual Life Outcomes 2018; 16:113. [PMID: 29859113 PMCID: PMC5984791 DOI: 10.1186/s12955-018-0942-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/22/2018] [Indexed: 01/17/2023] Open
Abstract
Background The aim of this study was to examine whether work capabilities differ between workers with Multiple Sclerosis (MS) and workers from the general population. The second aim was to investigate whether the capability set was related to work and health outcomes. Methods A total of 163 workers with MS from the MS@Work study and 163 workers from the general population were matched for gender, age, educational level and working hours. All participants completed online questionnaires on demographics, health and work functioning. The Capability Set for Work Questionnaire was used to explore whether a set of seven work values is considered valuable (A), is enabled in the work context (B), and can be achieved by the individual (C). When all three criteria are met a work value can be considered part of the individual’s ‘capability set’. Results Group differences and relationships with work and health outcomes were examined. Despite lower physical work functioning (U = 4250, p = 0.001), lower work ability (U = 10591, p = 0.006) and worse self-reported health (U = 9091, p ≤ 0.001) workers with MS had a larger capability set (U = 9649, p ≤ 0.001) than the general population. In workers with MS, a larger capability set was associated with better flexible work functioning (r = 0.30), work ability (r = 0.25), self-rated health (r = 0.25); and with less absenteeism (r = − 0.26), presenteeism (r = − 0.31), cognitive/neuropsychiatric impairment (r = − 0.35), depression (r = − 0.43), anxiety (r = − 0.31) and fatigue (r = − 0.34). Conclusions Workers with MS have a larger capability set than workers from the general population. In workers with MS a larger capability set was associated with better work and health outcomes. Trial registration This observational study is registered under NL43098.008.12: ‘Voorspellers van arbeidsparticipatie bij mensen met relapsing-remitting Multiple Sclerose’. The study is registered at the Dutch CCMO register (https://www.toetsingonline.nl). This study is approved by the METC Brabant, 12 February 2014. First participants are enrolled 1st of March 2014.
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Affiliation(s)
- D A M van Gorp
- National Multiple Sclerosis Foundation, Mathenesserlaan 378, Rotterdam, 3023 HB, The Netherlands. .,Department of Psychology, Section Health, Medical and Neuropsychology, Leiden University, PO Box 9555, Leiden, 2300 RB, The Netherlands. .,Department of Neurology, Elisabeth-TweeSteden Hospital, PO Box 90151, Tilburg, 5000 LC, The Netherlands. .,Department of Care Ethics, University of Humanistic Studies, PO Box 797, Utrecht, 3500 AT, The Netherlands.
| | - J J L van der Klink
- Tilburg School of Social and Behavioural Sciences, Tranzo Scientific Centre for Care and Welfare, Tilburg University, PO Box 90153, Tilburg, 5000 LE, The Netherlands
| | - F I Abma
- Department of Community & Occupational Medicine, University of Groningen, University Medical Centre Groningen, PO Box 30001, Groningen, 9700 RB, The Netherlands
| | - P J Jongen
- Department of Community & Occupational Medicine, University of Groningen, University Medical Centre Groningen, PO Box 30001, Groningen, 9700 RB, The Netherlands.,MS4 Research Institute, Ubbergseweg 34, Nijmegen, 9522 KJ, The Netherlands
| | - I van Lieshout
- van Lieshout Arbo Advies, PO Box 325, Uden, 5400 AH, The Netherlands
| | - E P J Arnoldus
- Department of Neurology, Elisabeth-TweeSteden Hospital, PO Box 90151, Tilburg, 5000 LC, The Netherlands
| | - E A C Beenakker
- Department of Neurology, Medical Centre Leeuwarden, PO Box 888, Leeuwarden, 8901 BR, The Netherlands
| | - H M Bos
- Department of Neurology, St. Anna Hospital, PO Box 90, Geldrop, 5660 AB, The Netherlands
| | - J J J van Eijk
- Department of Neurology, Jeroen Bosch Hospital, PO Box 90153, s-Hertogenbosch, 2000 ME, The Netherlands
| | - J Fermont
- Department of Neurology, Amphia Hospital, PO Box 90158, Breda, 4800 RK, The Netherlands
| | - S T F M Frequin
- Department of Neurology, St. Antonius Hospital, PO Box 2500, Nieuwegein, 3430 EM, The Netherlands
| | - K de Gans
- Department of Neurology, Groene Hart Hospital, PO Box 1098, Gouda, 2800 BB, The Netherlands
| | - G J D Hengstman
- Department of Neurology, Catharina Hospital, PO Box 1350, Eindhoven, 5602 ZA, The Netherlands
| | - R M M Hupperts
- Department of Neurology, Zuyderland Medical Centre, PO Box 5500, Sittard, 6130 MB, The Netherlands
| | - J P Mostert
- Department of Neurology, Rijnstate Hospital, PO Box 9555, Arnhem, 6800 TA, The Netherlands
| | - P H M Pop
- Department of Neurology, VieCuri Medical Centre, PO Box 1926, Venlo, 5900 BX, The Netherlands
| | - W I M Verhagen
- Department of Neurology, Canisius-Wilhelmina Hospital, PO Box 9015, Nijmegen, 6500 GS, The Netherlands
| | - D Zemel
- Department of Neurology, Albert Schweitzer Hospital, PO Box 444, Dordrecht, 3300 AK, the Netherlands
| | - M A P Heerings
- National Multiple Sclerosis Foundation, Mathenesserlaan 378, Rotterdam, 3023 HB, The Netherlands
| | - M F Reneman
- Department of Rehabilitation Medicine, University Medical Centre Groningen, University of Groningen, PO Box 30.002, Haren, 9750 RA, the Netherlands
| | - H A M Middelkoop
- Department of Psychology, Section Health, Medical and Neuropsychology, Leiden University, PO Box 9555, Leiden, 2300 RB, The Netherlands.,Department of Neurology, Leiden University Medical Centre, PO Box 9600, Leiden, 2300 RC, The Netherlands
| | - L H Visser
- Department of Neurology, Elisabeth-TweeSteden Hospital, PO Box 90151, Tilburg, 5000 LC, The Netherlands.,Department of Care Ethics, University of Humanistic Studies, PO Box 797, Utrecht, 3500 AT, The Netherlands
| | - K van der Hiele
- National Multiple Sclerosis Foundation, Mathenesserlaan 378, Rotterdam, 3023 HB, The Netherlands.,Department of Psychology, Section Health, Medical and Neuropsychology, Leiden University, PO Box 9555, Leiden, 2300 RB, The Netherlands.,Department of Neurology, Elisabeth-TweeSteden Hospital, PO Box 90151, Tilburg, 5000 LC, The Netherlands
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15
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Uitdehaag B, Kobelt G, Berg J, Capsa D, Dalén J. New insights into the burden and costs of multiple sclerosis in Europe: Results for the Netherlands. Mult Scler 2017. [DOI: 10.1177/1352458517708663] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: To estimate the value of interventions in multiple sclerosis (MS) – where lifetime costs and outcomes cannot be observed – outcome data have to be combined with costs. This requires that cost data be regularly updated. Objectives and Methods: This study is part of a cross-sectional retrospective study in 16 countries collecting data on resource consumption and work capacity, health-related quality of life (HRQoL) and prevalent symptoms for patients with MS. Descriptive analyses are presented by level of severity, from the societal perspective, in EUR 2015. Results: A total of 382 patients (mean age: 54 years) participated in the Netherlands; 81% were below retirement age and of these, 31% were employed. Employment was inversely related to disease severity, and MS affected productivity at work for 82% of patients. Overall, 96% and 73% of patients experienced fatigue and cognitive difficulties, respectively, as a problem. Mean utility and annual costs were 0.744 and €23,100 at Expanded Disability Status Scale (EDSS) 0–3, 0.595 and €32,300 at EDSS 4–6.5, and 0.297 and €50,500 at EDSS 7–9. The mean cost of a relapse was estimated at €3000. Conclusion: This study provides current data on MS in the Netherlands that are important for the development of health policies and to estimate the value of current and future treatments.
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Affiliation(s)
- Bernard Uitdehaag
- MS Center Amsterdam, Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
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16
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Gross HJ, Watson C. Characteristics, burden of illness, and physical functioning of patients with relapsing-remitting and secondary progressive multiple sclerosis: a cross-sectional US survey. Neuropsychiatr Dis Treat 2017; 13:1349-1357. [PMID: 28572730 PMCID: PMC5441664 DOI: 10.2147/ndt.s132079] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although most patients with relapsing-remitting multiple sclerosis (RRMS) will develop secondary progressive multiple sclerosis (SPMS), little is known about the burden of multiple sclerosis by disease subtype. This study describes the burden of disease in terms of demographics, disease severity, symptoms, health care resource and disease-modifying therapy (DMT) utilization, work and activity impairment, and physical functioning of SPMS and RRMS patients. METHODS SPMS and RRMS patient responses from the 2012 and 2013 waves of the US National Health and Wellness Survey were evaluated to detect differences in demographics, disease severity, symptoms, and health care resource and DMT utilization. In addition, data from the Work Productivity and Activity Impairment and Short Form-36 questionnaires were analyzed. RESULTS SPMS patients were older than RRMS patients (mean age 55.7 vs 48.9 years; P<0.001); a lower proportion were female (56.2% with SPMS vs 71.6% with RRMS; P=0.002), and fewer SPMS than RRMS patients were employed (20.0% vs 39.7%; P<0.001). SPMS patients described their disease as more severe, reporting several neurological symptoms more frequently and higher hospitalization rates than RRMS patients. A lower percentage of SPMS than RRMS patients reported DMT use. SPMS patients had greater overall work and activity impairment than RRMS patients. After controlling for baseline characteristics, impairment in physical functioning was greater in SPMS patients. CONCLUSION Overall, SPMS patients had a higher burden of illness than RRMS patients, underscoring the need to treat RRMS patients early to delay disability progressing using therapies that are effective in real-world settings.
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Affiliation(s)
| | - Crystal Watson
- Health Economics and Outcomes Research, Biogen, Cambridge, MA, USA
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17
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Ahmad H, Taylor BV, van der Mei I, Colman S, O’Leary BA, Breslin M, Palmer AJ. The impact of multiple sclerosis severity on health state utility values: Evidence from Australia. Mult Scler 2016; 23:1157-1166. [DOI: 10.1177/1352458516672014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The measurement of health state utility values (HSUVs) for a representative sample of Australian people with multiple sclerosis (MS) has not previously been performed. Objectives: Our main aim was to quantify the HSUVs for different levels of disease severities in Australian people with MS. Method: HSUVs were calculated by employing a ‘judgement-based’ method that essentially creates EQ-5D-3L profiles based on WHOQOL-100 responses and then applying utility weights to each level in each dimension. A stepwise linear regression was used to evaluate the relationship between HSUVs and disease severity, classified as mild (Expanded Disability Status Scale (EDSS) levels: 0–3.5), moderate (EDSS levels: 4–6) and severe (EDSS levels: 6.5–9.5). Results: Mean HSUV for all people with MS was 0.53 (95% confidence interval (CI): 0.52–0.54). Utility decreased with increasing disease severity: 0.61 (95% CI: 0.60–0.62), 0.51 (95% CI: 0.50–0.52) and 0.40 (95% CI: 0.38–0.43) for mild, moderate and severe disease, respectively. Adjusted differences in mean HSUV between the three severity groups were statistically significant. Conclusion: For the first time in Australia, we have quantified the impact of increasing severity of MS on health utility of people with MS. The HSUVs we have generated will be useful in further health economic analyses of interventions that slow progression of MS.
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Affiliation(s)
- Hasnat Ahmad
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Sam Colman
- Covance Pty Ltd, North Ryde, NSW, Australia
| | | | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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18
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Hawton AJ, Green C. Multiple sclerosis: relapses, resource use, and costs. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:875-884. [PMID: 26438399 DOI: 10.1007/s10198-015-0728-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 09/08/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Relapses can have a major impact on the lives of people with multiple sclerosis (MS), and yet relapse-related healthcare costs have received little attention. This has limited cost-effectiveness analyses of treatments for MS and hampered decision-making regarding the funding of MS healthcare services. OBJECTIVE To describe health/social care resource use and costs according to the frequency, severity, and endurance of MS relapses. METHODS Data from the prospective, longitudinal UK South West Impact of Multiple Sclerosis cohort were used. A total of 11,800 questionnaires from 1441 people with MS were available, including data on relapses, contacts with health/social care professionals, and other MS-related resource use. RESULTS The mean (SD) 6-monthly MS-related health/social care cost for individuals who reported a relapse was £519 (£949), compared to £229 (£366) for those who had not did report a relapse. Care costs varied widely dependent on the characteristics of the relapse. The mean (SD) cost when a relapse was not treated with steroids was £381 (£780), whilst the equivalent cost was £3579 (£1727) when a relapse resulted in hospitalization. CONCLUSIONS The impact of relapses on health and social care resources and costs differs according to their frequency, length, and severity. The data provided here can be used in cost-effectiveness analyses and to inform decision-making regarding healthcare provision for people with this condition.
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Affiliation(s)
- A J Hawton
- Health Economics Group, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Magdalen Road, Exeter, Devon, EX1 2LU, UK.
| | - C Green
- Health Economics Group, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Magdalen Road, Exeter, Devon, EX1 2LU, UK
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19
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Ernstsson O, Gyllensten H, Alexanderson K, Tinghög P, Friberg E, Norlund A. Cost of Illness of Multiple Sclerosis - A Systematic Review. PLoS One 2016; 11:e0159129. [PMID: 27411042 PMCID: PMC4943600 DOI: 10.1371/journal.pone.0159129] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 06/28/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cost-of-illness (COI) studies of Multiple Sclerosis (MS) are vital components for describing the economic burden of MS, and are frequently used in model studies of interventions of MS. We conducted a systematic review of studies estimating the COI of MS, to compare costs between studies and examine cost drivers, emphasizing generalizability and methodological choices. MATERIAL AND METHOD A literature search on studies published in English on COI of MS was performed in PubMed for the period January 1969 to January 2014, resulting in 1,326 publications. A mapping of studies using a bottom-up approach or top-down approach, respectively, was conducted for the 48 studies assessed as relevant. In a second analysis, the cost estimates were compared between the 29 studies that used a societal perspective on costs, human capital approach for indirect costs, presenting number of patients included, time-period studied, and year of price level used. RESULTS The mapping showed that bottom-up studies and prevalence approaches were most common. The cost ratios between different severity levels within studies were relatively stable, to the ratio of 1 to 2 to 3 for disability level categories. Drugs were the main cost drivers for MS-patients with low disease severity, representing 29% to 82% of all costs in this patient group, while the main cost components for groups with more advanced MS symptoms were production losses due to MS and informal care, together representing 17% to 67% of costs in those groups. CONCLUSION The bottom-up method and prevalence approach dominated in studies of COI of MS. Our findings show that there are difficulties in comparing absolute costs across studies, nevertheless, the relative costs expressed as cost ratios, comparing different severity levels, showed higher resemblance. Costs of drugs were main cost drivers for less severe MS and informal care and production losses for the most severe MS.
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Affiliation(s)
- Olivia Ernstsson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Hanna Gyllensten
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Kristina Alexanderson
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Petter Tinghög
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- The Swedish Red Cross University College, Stockholm, Sweden
| | - Emilie Friberg
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Anders Norlund
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
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20
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van der Hiele K, van Gorp DAM, Heerings MAP, van Lieshout I, Jongen PJ, Reneman MF, van der Klink JJL, Vosman F, Middelkoop HAM, Visser LH. The MS@Work study: a 3-year prospective observational study on factors involved with work participation in patients with relapsing-remitting Multiple Sclerosis. BMC Neurol 2015; 15:134. [PMID: 26264389 PMCID: PMC4531500 DOI: 10.1186/s12883-015-0375-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/08/2015] [Indexed: 12/05/2022] Open
Abstract
Background Multiple Sclerosis (MS) is the most common cause of neurological disability in young and middle-aged adults. At this stage in life most people are in the midst of their working career. The majority of MS patients are unable to retain employment within 10 years from disease onset. Leading up to unemployment, many may experience a reduction in hours or work responsibilities and increased time missed from work. The MS@Work study examines various factors that may influence work participation in relapsing-remitting MS patients, including disease-related factors, the working environment and personal factors. Methods/design The MS@Work study is a multicenter, 3-year prospective observational study on work participation in patients with relapsing-remitting MS. We aim to include 350 patients through 15–18 MS outpatient clinics in the Netherlands. Eligible participants are 18 years and older, and either currently employed or within three years since their last employment. At baseline and after 1, 2 and 3 years, the participants are asked to complete online questionnaires (including questions on work participation, work problems and accommodations, cognitive and physical ability, anxiety, depression, psychosocial stress, quality of life, fatigue, empathy, personality traits and coping strategies) and undergo cognitive and neurological examinations. After six months, patients are requested to only complete online questionnaires. Patient perspectives on maintaining and improving work participation and reasons to stop working are gathered through semi-structured interviews in a sub-group of patients. Discussion Prospective studies with long-term follow-up on work participation in MS are rare, or take into account a limited number of factors. The MS@Work study provides a 3-year follow-up on various factors that may influence work participation in patients with relapsing-remitting MS. We aim to identify factors that relate to job loss and to provide information about preventative measures for physicians, psychologists and other professionals working in the field of occupational health.
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Affiliation(s)
- Karin van der Hiele
- National Multiple Sclerosis Foundation, Mathenesserlaan 378, Rotterdam, 3023HB, The Netherlands. .,Department of Psychology, Section Health, Medical and Neuropsychology, Leiden University, PO Box 9555, Leiden, 2300 RB, The Netherlands. .,Department of Neurology, St. Elisabeth-TweeSteden Hospital, PO Box 90151, Tilburg, 5000 LC, The Netherlands.
| | - Dennis A M van Gorp
- National Multiple Sclerosis Foundation, Mathenesserlaan 378, Rotterdam, 3023HB, The Netherlands. .,Department of Psychology, Section Health, Medical and Neuropsychology, Leiden University, PO Box 9555, Leiden, 2300 RB, The Netherlands. .,Department of Neurology, St. Elisabeth-TweeSteden Hospital, PO Box 90151, Tilburg, 5000 LC, The Netherlands. .,University of Humanistic Studies, PO Box 797, Utrecht, 3500 AT, The Netherlands.
| | - Marco A P Heerings
- National Multiple Sclerosis Foundation, Mathenesserlaan 378, Rotterdam, 3023HB, The Netherlands.
| | - Irma van Lieshout
- van Lieshout Arbo Advies, PO Box 325, Uden, 5400 AH, The Netherlands.
| | - Peter J Jongen
- MS4 Research Institute, Ubbergseweg 34, Nijmegen, 6522 KJ, The Netherlands. .,Department of Community & Occupational Medicine, University Medical Center Groningen, Ant. Deusinglaan 1, PO Box 30001, Groningen, 9713 AV, The Netherlands.
| | - Michiel F Reneman
- University Medical Centre Groningen, Centre for Rehabilitation, University of Groningen, PO Box 30.002, Haren, 9750 RA, The Netherlands.
| | - Jac J L van der Klink
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, Tilburg, 5000 LE, The Netherlands.
| | - Frans Vosman
- University of Humanistic Studies, PO Box 797, Utrecht, 3500 AT, The Netherlands.
| | - Huub A M Middelkoop
- Department of Psychology, Section Health, Medical and Neuropsychology, Leiden University, PO Box 9555, Leiden, 2300 RB, The Netherlands. .,Department of Neurology, Leiden University Medical Centre, PO Box 9600, Leiden, 2300 RC, The Netherlands.
| | - Leo H Visser
- Department of Neurology, St. Elisabeth-TweeSteden Hospital, PO Box 90151, Tilburg, 5000 LC, The Netherlands. .,University of Humanistic Studies, PO Box 797, Utrecht, 3500 AT, The Netherlands.
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Takemoto MLS, Lopes da Silva N, Ribeiro-Pereira ACP, Schilithz AOC, Suzuki C. Differences in utility scores obtained through Brazilian and UK value sets: a cross-sectional study. Health Qual Life Outcomes 2015; 13:119. [PMID: 26246238 PMCID: PMC4527221 DOI: 10.1186/s12955-015-0318-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 07/29/2015] [Indexed: 01/29/2023] Open
Abstract
Background Multiple sclerosis (MS) is a chronic disease associated with several impacts; especially regarding patients’ health-related quality of life (HRQL). EuroQol 5 Dimensions questionnaire (EQ-5D) provides self-reported analysis of HRQL and utility scores. Although the British algorithm to convert EQ-5D responses into utility is the most used in the literature, national settings is more appropriate for health policy decision makers. A Brazilian algorithm is available, but not used in MS patients yet. Primarily, this study aimed to address potential differences in utility scores obtained through Brazilian and British value sets. Secondary objective was to determine the role of disability, fatigue and patients socio-demographic and clinical characteristics relevant to MS on the utility scores reported by Brazilian patients. Methods Cross-sectional study with MS patients treated in 8 Brazilian sites. Patients were interviewed about socio-demographic and clinical characteristics, self-reported disability level, HRQL and impact of fatigue on daily living. Disability level, HRQL and impact of fatigue were assessed using the Expanded Disability Status Scale (EDSS) and the Brazilian versions of EQ-5D-3L and Modified Fatigue Impact Scale (MFIS-BR), respectively. Patients were classified in subgroups according to EDSS (mild: 0–3; moderate: 4–6.5; severe: >7) and the self-perceived impact of fatigue (absent: ≤38 points; low: 39–58; high: ≥59). EQ-5D-3 L data was converted into a utility index using an algorithm developed by a Brazilian research group (QALY Brazil) and also the UK algorithm. Differences between utility scores were analysed through Wilcoxon test. Results Two hundred and ten patients were included in the study. Utility index mean scores of 0.59 (SD = 0.22) and 0.56 (SD = 0.32) for the Brazilian and UK algorithms were observed, respectively, without statistically significant difference for the distribution of data (p = 0.586). However, when utility scores were lower than 0.5, Brazilian algorithm provided higher estimates than UK with a better agreement between the scores found closer to 1. The same trend was observed when data was stratified for EDSS and impact of fatigue, with statistically significant difference between scores in categories of mild/severe disabilities and absent/high impact of fatigue. Conclusions Results suggest that Brazilian value set provided higher utility scores than the UK, particularly for measures below 0.5.
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Affiliation(s)
| | | | | | | | - Cibele Suzuki
- Novartis Biociências S.A., Avenida Prof. Vicente Rao, 90, São Paulo, SP, Brazil.
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Jongen PJ, Heerings M, Lemmens WA, Donders R, van der Zande A, van Noort E, Kool A. A prospective web-based patient-centred interactive study of long-term disabilities, disabilities perception and health-related quality of life in patients with multiple sclerosis in The Netherlands: the Dutch Multiple Sclerosis Study protocol. BMC Neurol 2015; 15:128. [PMID: 26238866 PMCID: PMC4524214 DOI: 10.1186/s12883-015-0379-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the past two decades the widespread use of disease modifying drugs with moderate to strong efficacy has changed the natural course of multiple sclerosis (MS). Health care professionals, researchers, patient organizations and health authorities are in need of recent information about the objectified and subjective long-term clinical outcomes in MS patients. Such information is scarce. METHODS/DESIGN We started a prospective, web-based, patient-centred, interactive study of long-term disabilities, disabilities perception and health-related quality of life (HRQoL) in MS patients in The Netherlands (Dutch Multiple Sclerosis Study). The study has an on online patient-driven inclusion and online acquisition of patient-reported outcomes (PROs). At six-months intervals participants complete the Multiple Sclerosis Impact Profile (MSIP) (disabilities and disabilities perception in seven domains and four symptoms), the Multiple Sclerosis Quality of Life-54 items (MSQoL-54), the Modified Fatigue Impact Scale-5 items (MFIS-5) and the Leeds Multiple Sclerosis Quality of Life-8 items (LMSQoL) questionnaires, and a Medication and Adherence Inventory. Every three years the Expanded Disability Status Scale (EDSS) score is assessed by phone. The monthly completion of the MFIS-5, LMSQoL and Medication and Adherence Inventory is optional. Completed questionnaires and inventories, and automatically generated scores are made available online to patients for self-monitoring and self-management purposes, and to authorized health care professionals for the evaluation of disease activity and of the effectiveness of treatments. Study duration is planned to be 15 years. Results will be analyzed periodically using means and standard deviations for continuous variables, and frequencies for categorical variables. Relations between time points, variables, patient and treatment characteristics will be evaluated in random effects repeated measures models. DISCUSSION The Dutch Multiple Sclerosis Study is characterized by online patient-driven inclusion; online data acquisition; the use of PROs; the optional monthly completion of short questionnaires; the interactive use of personal study data by patients and authorized health care professionals for self-monitoring, self-management and multidisciplinary care; the expected representativeness of the study sample; and a long-term time horizon. The study will provide valuable data on long-term disabilities, disabilities perceptions and HRQoL in MS patients in The Netherlands.
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Affiliation(s)
- Peter Joseph Jongen
- Department of Community & Occupational Medicine, University Medical Centre Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands. .,MS4 Research Institute, Ubbergseweg 34, 6522 KJ, Nijmegen, The Netherlands.
| | - Marco Heerings
- MH-Advies & organisatiebureau, IJselstraat 81, 9406 TR, Assen, The Netherlands. .,National MS Foundation The Netherlands, Mathenesserlaan 378, 3023 HB, Rotterdam, The Netherlands.
| | - Wim A Lemmens
- Department for Health Evidence, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Rogier Donders
- Department for Health Evidence, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Anneke van der Zande
- National MS Foundation The Netherlands, Mathenesserlaan 378, 3023 HB, Rotterdam, The Netherlands.
| | - Esther van Noort
- Curavista bv, Markt 9, 4931 BR, Geertruidenberg, The Netherlands.
| | - Anton Kool
- Curavista bv, Markt 9, 4931 BR, Geertruidenberg, The Netherlands.
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Stawowczyk E, Malinowski KP, Kawalec P, Moćko P. The indirect costs of multiple sclerosis: systematic review and meta-analysis. Expert Rev Pharmacoecon Outcomes Res 2015; 15:759-86. [DOI: 10.1586/14737167.2015.1067141] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fromont A, Lehanneur MN, Rollot F, Weill A, Clerc L, Bonithon Kopp C, Binquet C, Moreau T. Coûts de la sclérose en plaques en France. Rev Neurol (Paris) 2014; 170:432-9. [DOI: 10.1016/j.neurol.2014.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/27/2014] [Accepted: 02/19/2014] [Indexed: 11/26/2022]
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25
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Koch MW, Murray TJ, Fisk J, Greenfield J, Bhan V, Jacobs P, Brown M, Metz LM. Hand dexterity and direct disease related cost in multiple sclerosis. J Neurol Sci 2014; 341:51-4. [DOI: 10.1016/j.jns.2014.03.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/07/2014] [Accepted: 03/25/2014] [Indexed: 11/17/2022]
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Comparisons of Costs between Black Caribbean and White British Patients with Advanced Multiple Sclerosis in the UK. Mult Scler Int 2014; 2014:613701. [PMID: 24649365 PMCID: PMC3932720 DOI: 10.1155/2014/613701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/18/2013] [Accepted: 10/09/2013] [Indexed: 11/18/2022] Open
Abstract
Background. Multiple sclerosis (MS) is now more common among black and minority ethnic groups in the UK but little is known about the costs of care amongst different ethnic groups. Objective. This study examined and compared service use and costs for people severely affected with MS from Black Caribbean (BC) and White British (WB) backgrounds in the UK and identified predictors of cost for both groups. Method. Population-based cross-sectional study of 43 BC and 43 WB patients with MS (EDSS ≥ 6) and their informal caregivers recruited from an MS service in southeast London. Interviews collected data on health and social service use and informal care support. Costs were calculated using UK unit cost data. Using regression analyses we compared costs between the ethnic groups and identified possible predictors of cost. Results. The mean (SD) costs for the WB and BC groups were £ 25,778 ( £ 39,387) and £ 23,186 ( £ 30,433), respectively. Results identified no significant difference in total cost between the two ethnic groups. The EDSS score alone was a significant predictor of cost. Conclusion. Similar costs between ethnic groups indicate that with regard to this MS service and geographical area, access to care was not affected by ethnicity.
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Cho JY, Hong KS, Kim HJ, Kim SH, Min JH, Kim NH, Ahn SW, Park MS, An JY, Kim BJ, Kim W. Disability weight for each level of the Expanded Disability Status Scale in multiple sclerosis. Mult Scler 2014; 20:1217-23. [PMID: 24399825 DOI: 10.1177/1352458513518259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 12/04/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Expanded Disability Status Scale (EDSS) is the most widely employed ordinal disability scale in multiple sclerosis (MS). However, how far apart the individual EDSS levels are along the disability spectrum has not been formally quantified. OBJECTIVES The objective of this paper is to generate refined disability weights (DWs) for each of the ordinal EDSS levels. METHODS We performed the person trade-off (PTO) procedure to derive DWs of five representative EDSS categories (2, 4, 6, 7 and 9), and DWs of the remaining EDSS categories were assigned by linear interpolation. The modified Delphi process was used to achieve consensus among raters. RESULTS DWs were 0.021 for EDSS 2, 0.199 for EDSS 4, 0.313 for EDSS 6, 0.617 for EDSS 7, and 0.926 for EDSS 9. Panel members achieved a high degree of consensus for each DW, as indicated by low coefficients of variation. CONCLUSIONS Our DWs confirmed that EDSS is an ordinal scale with highly variable intervals. The availability of DW for each EDSS level allows direct comparison of each MS outcome state with other health states and provides a foundation for the estimation of the disability-adjusted life-years lost of individual patients.
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Affiliation(s)
- Joong-Yang Cho
- Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, South Korea
| | - Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, South Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, South Korea
| | - Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, South Korea
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, South Korea
| | - Nam-Hee Kim
- Department of Neurology, Dongguk University Ilsan Hospital, South Korea
| | - Suk-Won Ahn
- Department of Neurology, Chung-Ang University College of Medicine, South Korea
| | - Min Su Park
- Department of Neurology, Yeungnam University College of Medicine, South Korea
| | - Jae-Young An
- Department of Neurology, St. Vincent's Hospital, The Catholic University of Korea, South Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University College of Medicine, South Korea
| | - Woojun Kim
- Department of Neurology, The Catholic University of Korea, South Korea
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Cohen JT. Walking speed and economic outcomes for walking-impaired patients with multiple sclerosis. Expert Rev Pharmacoecon Outcomes Res 2014; 10:595-603. [DOI: 10.1586/erp.10.60] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Karampampa K, Gustavsson A, van Munster ETL, Hupperts RMM, Sanders EACM, Mostert J, Sinnige OLGF, de Graaf J, Pop P, Miltenburger C, Groot MT, Relleke M, van der Hel WS. Treatment experience, burden, and unmet needs (TRIBUNE) in Multiple Sclerosis study: the costs and utilities of MS patients in The Netherlands. J Med Econ 2013; 16:939-50. [PMID: 23692584 DOI: 10.3111/13696998.2013.807267] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is an important, highly disabling neurological disease, common among young adults in The Netherlands. Nevertheless, only a few studies to date have measured the burden imposed by MS on society in The Netherlands. OBJECTIVES To estimate the cost and quality-of-life associated with MS in The Netherlands, while focusing on the burden of relapses and increasing disease severity. METHODS MS patients in The Netherlands (n = 263) completed a web-based questionnaire which captured information on demographics, disease characteristics and severity (Expanded Disability Status Scale [EDSS]), co-morbidities, relapses, resource consumption, utilities, fatigue and activities of daily living (ADL). RESULTS Most patients included in the study were receiving treatment for MS (76% of the sample). The mean cost per patient per year increased with worsening disability and was estimated at €30,938, €51,056, and €100,469 for patients with mild (EDSS 0-3), moderate (EDSS 4-6.5), and severe (EDSS 7-9) disability, respectively. The excess cost of relapses was estimated at €8195 among relapsing-remitting patients with EDSS score ≤5. The quality-of-life of patients decreased with disease progression and existence of relapses. CONCLUSIONS The cost of MS in The Netherlands was higher compared to the results of previous studies. The TRIBUNE study provides an important update on the economic burden of MS in The Netherlands in an era of more widespread use of disease-modifying therapies. It explores the cost of MS linked to relapses and disease severity and examines the impact of MS on additional health outcomes beyond utilities such as ADL and fatigue. STUDY LIMITATIONS Patients were selected from specialized treatment centers, therefore this sample may not be representative of the entire MS population in The Netherlands, i.e., few patients not receiving MS therapies were included. In addition, only a few patients with severe disability were included in the study sample; therefore, results for this disease severity sub-group should be interpreted with caution.
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Affiliation(s)
- Korinna Karampampa
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden.
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Rieckmann P, Boyko A, Centonze D, Coles A, Elovaara I, Havrdová E, Hommes O, Lelorier J, Morrow SA, Oreja-Guevara C, Rijke N, Schippling S. Future MS care: a consensus statement of the MS in the 21st Century Steering Group. J Neurol 2012; 260:462-9. [PMID: 22936203 PMCID: PMC3566385 DOI: 10.1007/s00415-012-6656-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 08/10/2012] [Accepted: 08/11/2012] [Indexed: 11/24/2022]
Abstract
The "MS in the 21st Century" initiative was established with the purpose of (1) defining how multiple sclerosis (MS) treatment and standards of care should look in the 21st century; (2) developing a minimum standard of care across the world; and (3) motivating the broad MS community to align standards of care and challenge the current treatment paradigm. The aim was to develop a consensus statement to reach and influence the broader MS community. An expert steering group from Europe and Canada-consisting of neurologists, patient advocates, a pharmacoepidemiologist/pharmacoeconomist, and representatives from national MS centers-participated in a series of workshop-driven meetings between February 2011 and 2012. After three phases of discussions, the steering group identified that the overall vision for future care of MS should be full access to personalized treatment, with reimbursement, to achieve freedom from disease. They constructed seven overall principles that support this vision: personalized care, patient engagement, commitment to research, regulatory body education and reimbursement issues, new endpoints in clinical trials, more therapy options, and MS centers of excellence. This consensus statement outlines the key aspects of the seven principles that need to be addressed. The "MS in the 21st Century Steering Group" hopes that this consensus statement acts as a call to action for healthcare providers and decision-makers to address simultaneously the overarching principles that will guide patient management in order to improve outcomes for people with MS.
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Affiliation(s)
- Peter Rieckmann
- Department of Neurology, Sozialstiftung Bamberg Hospital, Bamberg, Germany.
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Hermans J, Koopmanschap MA, Bierma-Zeinstra SMA, van Linge JH, Verhaar JAN, Reijman M, Burdorf A. Productivity costs and medical costs among working patients with knee osteoarthritis. Arthritis Care Res (Hoboken) 2012; 64:853-61. [DOI: 10.1002/acr.21617] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Gustavsson A, Svensson M, Jacobi F, Allgulander C, Alonso J, Beghi E, Dodel R, Ekman M, Faravelli C, Fratiglioni L, Gannon B, Jones DH, Jennum P, Jordanova A, Jönsson L, Karampampa K, Knapp M, Kobelt G, Kurth T, Lieb R, Linde M, Ljungcrantz C, Maercker A, Melin B, Moscarelli M, Musayev A, Norwood F, Preisig M, Pugliatti M, Rehm J, Salvador-Carulla L, Schlehofer B, Simon R, Steinhausen HC, Stovner LJ, Vallat JM, Van den Bergh P, van Os J, Vos P, Xu W, Wittchen HU, Jönsson B, Olesen J. Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011; 21:718-79. [PMID: 21924589 DOI: 10.1016/j.euroneuro.2011.08.008] [Citation(s) in RCA: 985] [Impact Index Per Article: 75.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The spectrum of disorders of the brain is large, covering hundreds of disorders that are listed in either the mental or neurological disorder chapters of the established international diagnostic classification systems. These disorders have a high prevalence as well as short- and long-term impairments and disabilities. Therefore they are an emotional, financial and social burden to the patients, their families and their social network. In a 2005 landmark study, we estimated for the first time the annual cost of 12 major groups of disorders of the brain in Europe and gave a conservative estimate of €386 billion for the year 2004. This estimate was limited in scope and conservative due to the lack of sufficiently comprehensive epidemiological and/or economic data on several important diagnostic groups. We are now in a position to substantially improve and revise the 2004 estimates. In the present report we cover 19 major groups of disorders, 7 more than previously, of an increased range of age groups and more cost items. We therefore present much improved cost estimates. Our revised estimates also now include the new EU member states, and hence a population of 514 million people. AIMS To estimate the number of persons with defined disorders of the brain in Europe in 2010, the total cost per person related to each disease in terms of direct and indirect costs, and an estimate of the total cost per disorder and country. METHODS The best available estimates of the prevalence and cost per person for 19 groups of disorders of the brain (covering well over 100 specific disorders) were identified via a systematic review of the published literature. Together with the twelve disorders included in 2004, the following range of mental and neurologic groups of disorders is covered: addictive disorders, affective disorders, anxiety disorders, brain tumor, childhood and adolescent disorders (developmental disorders), dementia, eating disorders, epilepsy, mental retardation, migraine, multiple sclerosis, neuromuscular disorders, Parkinson's disease, personality disorders, psychotic disorders, sleep disorders, somatoform disorders, stroke, and traumatic brain injury. Epidemiologic panels were charged to complete the literature review for each disorder in order to estimate the 12-month prevalence, and health economic panels were charged to estimate best cost-estimates. A cost model was developed to combine the epidemiologic and economic data and estimate the total cost of each disorder in each of 30 European countries (EU27+Iceland, Norway and Switzerland). The cost model was populated with national statistics from Eurostat to adjust all costs to 2010 values, converting all local currencies to Euro, imputing costs for countries where no data were available, and aggregating country estimates to purchasing power parity adjusted estimates for the total cost of disorders of the brain in Europe 2010. RESULTS The total cost of disorders of the brain was estimated at €798 billion in 2010. Direct costs constitute the majority of costs (37% direct healthcare costs and 23% direct non-medical costs) whereas the remaining 40% were indirect costs associated with patients' production losses. On average, the estimated cost per person with a disorder of the brain in Europe ranged between €285 for headache and €30,000 for neuromuscular disorders. The European per capita cost of disorders of the brain was €1550 on average but varied by country. The cost (in billion €PPP 2010) of the disorders of the brain included in this study was as follows: addiction: €65.7; anxiety disorders: €74.4; brain tumor: €5.2; child/adolescent disorders: €21.3; dementia: €105.2; eating disorders: €0.8; epilepsy: €13.8; headache: €43.5; mental retardation: €43.3; mood disorders: €113.4; multiple sclerosis: €14.6; neuromuscular disorders: €7.7; Parkinson's disease: €13.9; personality disorders: €27.3; psychotic disorders: €93.9; sleep disorders: €35.4; somatoform disorder: €21.2; stroke: €64.1; traumatic brain injury: €33.0. It should be noted that the revised estimate of those disorders included in the previous 2004 report constituted €477 billion, by and large confirming our previous study results after considering the inflation and population increase since 2004. Further, our results were consistent with administrative data on the health care expenditure in Europe, and comparable to previous studies on the cost of specific disorders in Europe. Our estimates were lower than comparable estimates from the US. DISCUSSION This study was based on the best currently available data in Europe and our model enabled extrapolation to countries where no data could be found. Still, the scarcity of data is an important source of uncertainty in our estimates and may imply over- or underestimations in some disorders and countries. Even though this review included many disorders, diagnoses, age groups and cost items that were omitted in 2004, there are still remaining disorders that could not be included due to limitations in the available data. We therefore consider our estimate of the total cost of the disorders of the brain in Europe to be conservative. In terms of the health economic burden outlined in this report, disorders of the brain likely constitute the number one economic challenge for European health care, now and in the future. Data presented in this report should be considered by all stakeholder groups, including policy makers, industry and patient advocacy groups, to reconsider the current science, research and public health agenda and define a coordinated plan of action of various levels to address the associated challenges. RECOMMENDATIONS Political action is required in light of the present high cost of disorders of the brain. Funding of brain research must be increased; care for patients with brain disorders as well as teaching at medical schools and other health related educations must be quantitatively and qualitatively improved, including psychological treatments. The current move of the pharmaceutical industry away from brain related indications must be halted and reversed. Continued research into the cost of the many disorders not included in the present study is warranted. It is essential that not only the EU but also the national governments forcefully support these initiatives.
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Kanters TA, Hagemans MLC, van der Beek NAME, Rutten FFH, van der Ploeg AT, Hakkaart L. Burden of illness of Pompe disease in patients only receiving supportive care. J Inherit Metab Dis 2011; 34:1045-52. [PMID: 21499718 PMCID: PMC3173621 DOI: 10.1007/s10545-011-9320-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 03/16/2011] [Accepted: 03/20/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pompe disease is an orphan disease for which enzyme replacement therapy (ERT) recently became available. This study aims to estimate all relevant aspects of burden of illness--societal costs, use of home care and informal care, productivity losses, and losses in health-related quality of life (HRQoL)--for adult Pompe patients only receiving supportive care. METHODS We collected data on all relevant aspects of burden of illness via a questionnaire. We applied a societal perspective in calculating costs. The EQ-5D was used to estimate HRQoL. RESULTS Eighty adult patients (87% of the total Dutch adult Pompe population) completed a questionnaire. Disease severity ranged from mild to severe. Total annual costs were estimated at <euro>22,475 (range <euro>0-169,539) per adult Pompe patient. Patients on average received 8 h of home care and 19 h of informal care per week. Eighty-five percent of the patients received informal care from one or more caregivers; 40% had stopped working due to their disease; another 20% had reduced their working hours. HRQoL for Pompe patients who only received supportive care was estimated at 0.72, 17% lower than the Dutch population at large. CONCLUSIONS Adult Pompe disease is associated with a considerable burden of illness at both the societal and patient levels. The disease leads to substantial costs and dependency on medical devices, home care, and informal care, and has a high impact on the patient's social network. In addition, patients are limited in their ability to work and have significantly reduced HRQoL.
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Affiliation(s)
- Tim A Kanters
- Department of Health Policy & Management, Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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Blahova Dusankova J, Kalincik T, Dolezal T, Kobelt G, Havrdova E. Cost of multiple sclerosis in the Czech Republic: The COMS study. Mult Scler 2011; 18:662-8. [DOI: 10.1177/1352458511424422] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Information about cost of multiple sclerosis (MS) is available from a number of European countries, but no data from the Czech Republic have been published so far. Objective: The objective of this study was to establish the cost of MS in the Czech Republic, overall and by level of disease severity. Methods: Data on demographics, disease history, resource consumption and production losses were collected from 909 patients recruited in 7 MS centres in the Czech Republic. Annual costs were estimated in the societal perspective, using 2007 unit costs. To evaluate the relationship between disability and costs, patients were stratified into those with mild (67%), moderate (27%) and severe (10%) disability using the Expanded Disability Status Scale. Results: Mean total annual costs per patient were €12,272, of which 51% were direct medical costs, 4% direct non-medical costs and 45% indirect costs. The average annual costs in patients with mild, moderate and severe disability amounted to €9905, €14,064 and €22,880, respectively. Conclusion: The total costs of MS in the Czech Republic are estimated at €208.6 million per year. Consistent with other studies, the costs increase significantly with the severity of MS.
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Affiliation(s)
- J Blahova Dusankova
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - T Kalincik
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - T Dolezal
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic
- Department of Pharmacology, Charles University in Prague, 3rd Faculty of Medicine, Czech Republic; and
| | - G Kobelt
- Department of Orthopaedics, University of Lund, Sweden
| | - E Havrdova
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital in Prague, Czech Republic
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Romero M, Arango C, Alvis N, Suarez JC, Duque A. [The cost of treatment of multiple sclerosis in Colombia]. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:S48-S50. [PMID: 21839899 DOI: 10.1016/j.jval.2011.05.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To estimate, according to the states of disease (remission or relapse) and her level of progression (EDSS), the cost of treatment of Multiple Sclerosis (MS) in Colombia. METHODS From the perspective of the third payer, a cost study of MS was performed using two-way estimation techniques: a) "Top down" to estimate the costs during relapses from clinical registers of 304 patients; b) "bottom-up" to estimate the cost in remission from a questionnaire (Kobelt 2006) applied to 137 patients, located in different regions of Colombia. RESULTS The mean of patient's age was 43,7 years and 73% of those were women. The mean annual cost per patient varied according to the disease phase, finding the highest value in Phase II (EDSS 3 - 5,5) with $ 50.581.216 COP (US$ 25.713) and the lowest one in Phase IV (EDSS 8 - 9,5) with $20.738.845 COP (US$ 10.543). The cost of Disease Modifier Drugs (DMD) represented 91.5% from the medial total annual cost of 1,2 and 3 phases. The participation of DMD was 58%.in the 4 phase. Indirect costs are minimal participation in all phases, except for 4 where increases at the expense of reduced consumption of DMD. Costs associated with the period of relapses of MS are low against the total cost, with an average cost of $ 2,433,182 COP ($ 1.237 USD). DISCUSSION MS in Colombia is a disease with a behavioral pathology "high cost " to the social security system (SGSSS), generated mainly at the expense of their direct costs, which, even without including relapses, an aggregate amount of more than 75 times the annual premium cost of health insurance for Colombia ($ 430,488 COP) in the year under review (2008).
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Affiliation(s)
- Martin Romero
- Fundación Salutia Centro de investigaciones económicas, de gestión y tecnologías en salud, Bogotá, Colombia.
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Jobin C, Larochelle C, Parpal H, Coyle PK, Duquette P. Gender issues in multiple sclerosis: an update. ACTA ACUST UNITED AC 2011; 6:797-820. [PMID: 21118039 DOI: 10.2217/whe.10.69] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Although multiple sclerosis (MS) affects both women and men, women are more susceptible to MS than men. Accumulating evidence indicates that the incidence and prevalence of MS is increasing, more so in women than in men. Owing to pregnancy, differing hormonal states and distinct social roles, the impact of MS differs between women and men. Since Patricia K Coyle published a review on gender issues in MS, multiple studies have added to the body of knowledge. This update will summarize the current thinking on gender-related issues in MS and we will address incidence and prevalence, hormonal factors, pregnancy and breastfeeding, genetics, course and prognosis, imaging, treatment and psychosocial aspects. Future progression within this field will help elucidate the cause of and define the treatment of MS.
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Sharac J, McCrone P, Sabes-Figuera R. Pharmacoeconomic considerations in the treatment of multiple sclerosis. Drugs 2010; 70:1677-91. [PMID: 20731475 DOI: 10.2165/11538000-000000000-00000] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Multiple sclerosis (MS) is a disorder that incurs high costs to individuals, health systems and society as a whole. A growing number of studies have measured the costs of MS and assessed the cost effectiveness of different treatments. This review summarizes the evidence from these studies. Electronic databases were searched and a total of 51 studies were included, 32 of which were cost-of-illness studies. The cost-of-illness studies took different perspectives (health service or societal) and the annual costs per person with MS ranged between $US6511 and $US77,938 (year of cost 2008). Economic evaluations of interferon (IFN)-beta-1a, IFNbeta-1b, glatiramer acetate, natalizumab, mitoxantrone and cyclophosphamide were identified. The results of the cost effectiveness of drug interventions were mixed. Most results comparing a drug with placebo related to IFNbeta-1b and the results usually revealed cost-effectiveness ratios that were above usual willingness-to-pay thresholds of public decision makers. The limited evidence on glatiramer acetate suggests that this may be cost effective. Head-to-head drug comparisons produced varying results, although the findings for natalizumab appear favourable compared with other drugs. Further trial-based comparisons are required to increase the evidence base regarding drug treatments for MS.
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Affiliation(s)
- Jessica Sharac
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
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Fragoso YD, Finkelsztejn A, Giacomo MCB, Russo L, Cruz WS. The effect of multiple sclerosis on the professional life of a group of Brazilian patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:914-7. [DOI: 10.1590/s0004-282x2010000600016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 06/09/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: To assess the impact of multiple sclerosis (MS) on the professional life of Brazilian patients. METHOD: One hundred MS patients were randomly selected from the database of the Brazilian Multiple Sclerosis Association (ABEM). An individual interview was carried out by telephone by a member of ABEM, who collected data on the patients' clinical status, educational level and professional lives. RESULTS: Complete data were obtained from 96 patients (27 males and 69 females) aged 55.0±14.1 years, with average disease duration of 4.6±4.0 years). Eighty percent had eleven or more years of schooling. Among the whole group, 66% did not present limitations on walking. The longer the disease duration and the older the patient were, the higher the chances were that the patient was retired or receiving workers' compensation benefits. However, even among patients with MS for less than five years, the rate of non-participation in the workforce was 47.7%. Fatigue, paresthesia, cognitive dysfunction and pain were often cited as the motives for not working. CONCLUSION: MS patients presented high levels of unemployment, retirement and receipt of workers' compensation benefits, despite their high schooling levels. Age, disease duration and disability influenced these results for the whole group. However, even among younger patients with shorter disease duration and low disability, this finding remained.
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Naci H, Fleurence R, Birt J, Duhig A. The impact of increasing neurological disability of multiple sclerosis on health utilities: a systematic review of the literature. J Med Econ 2010; 13:78-89. [PMID: 20047364 DOI: 10.3111/13696990903543085] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a debilitating disease, accompanied by neurological symptoms of varying severity. Utilities are a key summary index measure used in assessing health-related quality of life in individuals with MS. OBJECTIVES To provide a systematic review of the literature on utilities of relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS) patients and to review changes in utilities associated with the increasing neurological disability of different stages of MS, as measured by the Expanded Disability Status Scale (EDSS). METHODS Employing pre-defined search terms and inclusion/exclusion criteria, systematic searches of the literature were conducted in EMBASE, MEDLINE, PsycINFO, the Health Economic Evaluation Database (HEED), and the NHS Economic Evaluations Database (NHS/EED). Proceedings for the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), the European Society for Treatment and Research in MS (ECTRIMS), the American Society for Treatment and Research in MS (ACTRIMS), and the Latin American Society for Treatment and Research in MS (LACTRIMS) were reviewed in addition to the UK National Institute for Health and Clinical Excellence website and the table of contents of PharmacoEconomics and Value in Health. RESULTS This review identified 18 studies reporting utilities associated with health states of MS. Utilities ranged from 0.80 to 0.92 for patients with an EDSS score of 1, from 0.49 to 0.71 for patients with an EDSS score of 3, from 0.39 to 0.54 for patients with an EDSS score of 6.5, and from -0.19 to 0.1 for patients with an EDSS score of 9. LIMITATIONS Several of the studies reviewed relied on data from patient organizations, which may not be fully representative of the general patient populations. Additionally, the majority of the studies relied on retrospective data collection. CONCLUSIONS Utilities decrease substantially with increasing neurological disability. Cross-country differences are minimal with utility scores following a similar pattern across countries for patients at similar disease severity levels. This consistency in findings is noteworthy, as there is a reliable evidence base for selecting utility values for economic evaluation analyses. However, more research is needed to explore potential differences in utilities between RRMS and SPMS patients.
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Affiliation(s)
- Huseyin Naci
- Center for Health Economics & Science Policy, United BioSource Corporation, 20 Bloomsbury Square, London, UK.
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Wundes A, Brown T, Bienen EJ, Coleman CI. Contribution of intangible costs to the economic burden of multiple sclerosis. J Med Econ 2010; 13:626-32. [PMID: 20950249 DOI: 10.3111/13696998.2010.525989] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is associated with a substantial economic burden resulting from direct medical costs associated with health and disability-related resource utilization and indirect costs relating to reduced productivity. However, reduced health-related quality of life (HR-QOL) may be associated with additional costs, often termed 'intangible costs,' that should be considered as part of the economic burden from the societal or patient perspectives. OBJECTIVES To review the contribution of intangible costs to the overall economic burden of MS. METHODS Medline was searched through March 2010 for relevant articles that included the terms 'multiple sclerosis' in combination with 'intangible costs,' 'QALY,' 'quality-adjusted life year,' 'willingness-to-pay,' and 'WTP.' Other than the restriction that the articles were published in English, there were no other exclusionary criteria for the search. Identified references were hand-searched to determine if intangible costs were estimated. RESULTS Thirteen studies across ten countries were identified that estimated intangible costs based on the number of quality-adjusted life-years (QALYs) lost due to a reduction in HR-QOL multiplied by accepted willingness-to-pay (WTP) thresholds. Although absolute costs varied depending on thresholds used and year of evaluation, the intangible costs accounted for 17.5-47.8% of total costs of MS. Furthermore, evidence suggested intangible costs are positively correlated with worsening disability. The largest increase in intangible costs occurred at the transition between mild and moderate disability. However, since no value has been established as being acceptable to pay for a QALY, a limitation of these studies was their dependence on the definition of the WTP threshold. CONCLUSIONS Intangible costs substantially add to the economic burden of MS. There is not only a need to further characterize these costs and incorporate them into economic studies, but also to determine how these costs can be reduced through appropriate management strategies.
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Affiliation(s)
- Annette Wundes
- Department of Neurology, University of Washington Medical Center, Seattle, WA 98195, USA.
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Naci H, Fleurence R, Birt J, Duhig A. Economic burden of multiple sclerosis: a systematic review of the literature. PHARMACOECONOMICS 2010; 28:363-379. [PMID: 20402540 DOI: 10.2165/11532230-000000000-00000] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Multiple sclerosis (MS) is a disease of the CNS, typically striking adults during the primary productive time of their life. The symptoms of MS can restrict the individual's physical activity and income-earning ability, resulting in a major financial burden on the patient, family, health system and society. This systematic literature review was conducted to document the economic burden of MS. Employing pre-defined search terms and inclusion/exclusion criteria, systematic searches were conducted in MEDLINE, EMBASE, PsycINFO, the Health Economic Evaluations Database (HEED), the NHS Economic Evaluation Database (EED) and the UK National Institute for Health and Clinical Excellence (NICE) website as well as conference abstracts. We identified 29 cost-of-illness studies that met the a priori inclusion criteria. The cost categories responsible for the majority of costs associated with MS varied across countries. There was a significant increase in costs associated with an increase in disease severity as measured by the Kurtzke Expanded Disability Status Scale (EDSS) score. The increase in magnitude was coupled with changes in the distribution of costs; although direct medical costs were important contributors in earlier stages of disease, they were outweighed by indirect costs in later stages, mainly due to relapses and productivity losses. Considering the increased costs associated with relapse occurrence and increasing disease severity, pharmaceutical or non-pharmaceutical interventions aimed at delaying the progression of disease may help to reduce the economic burden of MS.
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Affiliation(s)
- Huseyin Naci
- Center for Health Economics & Science Policy, United BioSource Corporation, London, UK
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Phillips CJ, Humphreys I. Assessing cost-effectiveness in the management of multiple sclerosis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2009; 1:61-78. [PMID: 21935308 PMCID: PMC3169986 DOI: 10.2147/ceor.s4225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Indexed: 11/23/2022] Open
Abstract
Multiple sclerosis (MS) is one of the most common causes of neurological disability in young and middle-aged adults, with current prevalence rates estimated to be 30 per 100,000 populations. Women are approximately twice as susceptible as males, but males are more likely to have progressive disease. The onset of the disease normally occurs between 20 and 40 years of age, with a peak incidence during the late twenties and early thirties, resulting in many years of disability for a large proportion of patients, many of whom require wheelchairs and some nursing home or hospital care. The aim of this study is to update a previous review which considered the cost-effectiveness of disease-modifying drugs (DMDs), such as interferons and glatiramer acetate, with more up to date therapies, such as mitaxantrone hydrochloride and natalizumab in the treatment of MS. The development and availability of new agents has been accompanied by an increased optimism that treatment regimens for MS would be more effective; that the number, severity and duration of relapses would diminish; that disease progression would be delayed; and that disability accumulation would be reduced. However, doubts have been expressed about the effectiveness of these treatments, which has only served to compound the problems associated with endeavors to estimate the relative cost-effectiveness of such interventions.
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Affiliation(s)
- Ceri J Phillips
- Institute for Health Research, School of Health Science, Swansea University, Swansea, Wales, UK
| | - Ioan Humphreys
- Institute for Health Research, School of Health Science, Swansea University, Swansea, Wales, UK
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Beckerman H, van Zee IE, de Groot V, van den Bos GAM, Lankhorst GJ, Dekker J. Utilization of health care by patients with multiple sclerosis is based on professional and patient-defined health needs. Mult Scler 2008; 14:1269-79. [PMID: 18653735 DOI: 10.1177/1352458508094884] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This cross-sectional study investigates healthcare utilization, and determines which predisposing, enabling, and health factors are associated with healthcare utilization among 121 patients with multiple sclerosis (MS). METHODS Data on patient-related predisposing, enabling, and health factors were collected by means of written questionnaires and a home visit from a well-trained physiotherapist. RESULTS Of the 121 patients with MS (mean age 43 years, mean score on the Expanded Disability Status Scale 3.5, disease duration 6 years), 16% were hospitalized in the previous year; 62% consulted their general practitioner, and 69% consulted their neurologist in the previous 6 months. Other medical specialists were consulted in the 6-month period by 50% of the study population. In a 4-week period preceding the home visit, 41% of the patients were treated by an allied healthcare professional. Multivariate logistic regression analyses showed that consulting the general practitioner, the neurologist, other medical specialists, and allied healthcare professionals, and the use of equipment/aids by MS patients is primarily related to their health, either as perceived by the patients themselves or defined by the professional. CONCLUSIONS MS patients in the Netherlands make appropriate use of healthcare facilities, because their utilization can predominantly be explained by health-related factors, and not by predisposing or enabling factors.
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Affiliation(s)
- H Beckerman
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
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Chronical illness and maternity: life conditions, quality of life and coping in women with multiple sclerosis. Qual Life Res 2007; 16:1587-94. [PMID: 17917791 DOI: 10.1007/s11136-007-9268-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 09/13/2007] [Indexed: 10/22/2022]
Abstract
AIM Research on life circumstances, quality of life (QOL) and coping behavior in mothers with multiple sclerosis (MS). METHOD Anonymous standardised questionnaire sent to 7,050 members of a section of the German MS Association (response rate 44.8%). Comparison of 482 mothers with MS (children aged < 18 years) with 607 childless women with MS. RESULTS No statistically significant differences concerning age, MS course, complaints or number of exacerbations. Mothers with MS more frequently had a relationship, a higher monthly net income, were less employed, EDSS-score was lower and disease duration shorter. In QOL mothers with MS showed better social aspects even after multivariate adjustment for sociodemographic and disease-related variables. Influencing parameters on the social area of QOL were employment status, age, monthly household net income and disability. In their coping behavior mothers tended more to "religiosity/search for sense in life". CONCLUSION There were several differences in sociodemographic data, QOL and coping behavior factors between mothers and childless women with MS. However, if motherhood itself has an influence on QOL and coping can not be derived from our data but there are some hints that motherhood seems to be no potential problem for living with the disease. Further research upon this topic is needed.
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