Impact of Mobility Impairment on Indirect Costs and Health-Related Quality of Life in Multiple Sclerosis

Craig I Coleman,Matthew S Roberts,Christine Kohn,Matthew F Sidovar,Fernando De Castro

doi:10.1371/journal.pone.0054756

Craig I Coleman, Matthew S Roberts + Show 3 more

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https://doi.org/10.1371/journal.pone.0054756

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Abstract

This study was conducted to estimate the indirect costs and health-related quality of life (HRQoL) (utilities) of multiple sclerosis (MS) patients in the United States (US), and to determine the impact of worsening mobility on these parameters. In collaboration with the North American Research Committee on Multiple Sclerosis (NARCOMS) registry we conducted a cross-sectional study of participants who completed the biannual update and supplemental spring 2010 survey. Demographic, employment status, income, mobility impairment, and health utility data were collected from a sample of registry participants who met the study criteria and agreed to participate in the supplemental Mobility Study. Mean annual indirect costs per participant in 2011US$ and mean utilities for the population and for cohorts reporting different levels of mobility impairment were estimated. Analyses included 3,484 to 3,611 participants, based on survey completeness. Thirty-seven percent of registrants were not working or attending school and 46.7% of these reported retiring early. Indirect costs per participant per year, not including informal caregiver cost, were estimated at $30,601±31,184. The largest relative increase in indirect costs occurred at earlier mobility impairment stages, regardless of the measure used. Participants’ mean utility score (0.73±0.18) was lower than that of a similarly aged sample from the general US population (0.87). As with indirect costs, larger decrements in utility were seen at earlier mobility impairment stages. These results suggest that mobility impairment may contribute to increases in indirect costs and declines in HRQoL in MS patients.

Highlights

Multiple Sclerosis (MS) is a chronic and progressive neurologic disease, characterized by diverse symptoms and deficits, which primarily strikes adults between the ages of 18 and 45 years [1]
As MS largely occurs in people of working age, it may have an adverse impact on employment status, work productivity, and healthrelated quality of life (HRQoL) [1,2,3]
Previous MS-related cost-of-illness studies have been published in the medical literature [4]; few were conducted within a United States (US) population and provided estimates of indirect costs and preference-based health status or utility (a patientreported measure of perceived health status with values between 1.0 and 0.0)

Summary

Introduction

Multiple Sclerosis (MS) is a chronic and progressive neurologic disease, characterized by diverse symptoms and deficits, which primarily strikes adults between the ages of 18 and 45 years [1]. As MS largely occurs in people of working age, it may have an adverse impact on employment status, work productivity, and healthrelated quality of life (HRQoL) [1,2,3]. Kobelt and colleagues [5,6] reported the costs of lost productivity (indirect costs) and pain and suffering (intangible costs) to be substantial, ranging on average from $17,581–$22,231 and $15,315 per patient per year, respectively, and to increase with worsening disease severity. This study used the Expanded Disability Status Scale (EDSS) to define worsening disease severity, stratifying patients by scores of 0–3.5, 4–6, and 6.5–9.5. While the EDSS is weighted towards mobility impairment in the middle of its scale, it may not be a robust or optimal measure of mobility impairment [7]

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