Abstract
BackgroundMultiple sclerosis (MS) is a central nervous system disease associated with irreversible progression of disability, which imposes a substantial socioeconomic onus. The objective of this study was to determine the economic impact of multiple sclerosis from the Brazilian household and healthcare system perspectives. Secondary objectives were to assess the impact of fatigue on daily living and health-related quality of life (HRQL) of MS patients.MethodsThis is a cross-sectional study in which Brazilian eligible patients attending eight major MS specialized sites answered an interview capturing data on demographics, disease characteristics and severity, comorbidities, resource utilization, fatigue, utilities and health-related quality of life from November/2011 to May/2012 . Costs were assessed considering a prevalence-based approach within 1 year of resource consumption and were estimated by multiplying the amount used by the corresponding unit cost. Patients were classified as having mild, moderate or severe disability according to the Expanded Disability Status Scale (EDSS).ResultsIn total, 210 patients who met eligibility criteria were included, 40 % had mild, 43 % moderate and 16 % severe disability; disability level was missing for 1 %. The average total direct cost per year was USD 19,012.32 (SD = 10,465.96), and no statistically significant differences were not observed according to MS disability level (p = 0.398). The use of disease modifying therapies (DMTs) corresponded to the majority of direct expenditures, especially among those patients with lower levels of disability, representing around 90 % of total costs for mild and moderate MS patients. It was also observed that expenses with medical (except DMTs) and non-medical resources are higher among patients with more severe disease. Worsening disability also had an important influence on health-related quality of life and self-perceived impact of fatigue on daily living.ConclusionOur data demonstrates the significant economic impact of MS on both Brazilian household and health system, in terms of DMTs and other disease management costs. When patients move upwards on the disease severity scale, costs with health resources other than drugs are significantly increased.
Highlights
Multiple sclerosis (MS) is a central nervous system disease associated with irreversible progression of disability, which imposes a substantial socioeconomic onus
Secondary objectives were to assess the impact of fatigue on daily living and healthrelated quality of life (HRQL) of MS patients
Patients’ demographics and clinical characteristics In total, 210 patients who met eligibility criteria were included in the study
Summary
Multiple sclerosis (MS) is a central nervous system disease associated with irreversible progression of disability, which imposes a substantial socioeconomic onus. Secondary objectives were to assess the impact of fatigue on daily living and health-related quality of life (HRQL) of MS patients. Multiple sclerosis (MS) is an inflammatory and demyelinating disease of the central nervous system that can cause several symptoms that include upper and lower extremity disabilities, visual disturbances, balance and coordination problems, spasticity, altered sensation, abnormal speech, swallowing disorders, fatigue, bladder and bowel problems, sexual dysfunction, and cognitive and emotional disturbances [1,2,3]. Intangible non-monetary adverse impacts of MS, such as health-related loss of quality of life and symptoms like fatigue, represent an important concern for patients and families [11,12,13]. Within the scope of economic analysis in health care, patients’ quality of life is usually translated into a measure related to economic theory named utility which was previously described for MS [3, 8, 9, 14,15,16,17,18]
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