Abstract
ObjectivesAs there were only regional studies in Hungary about the prevalence of multiple sclerosis (MS), we aimed to estimate its epidemiological features using data of Hungary’s single-payer health insurance system.MethodsPseudonymized database of claims reported by hospitals and outpatient services between 2004–2016 was analyzed and linked with an independent database of outpatient pharmacy refills between 2010–2016. We established an administrative case definition of MS and validated it on medical records of 309 consecutive patients. A subject was defined as MS-patient if received MS diagnosis (International Classification of Diseases, 10th edition, code G35) on three or more occasions at least in 2 calendar years and at least once documented by a neurologist. Patients were counted as incident cases in the year of the first submitted claim for MS. We allowed a 6-year-long run-in period, so only data between 2010–2015 are discussed.ResultsSensitivity of the administrative case definition turned out to be 99%, while specificity was >99%. Crude prevalence of MS has increased from 109.3/100,000 in 2010 to 130.8/100,000 in 2015 (p-value = 0.000003). Crude incidence declined from 7.1/100,000 (2010) to 5.4/100,000 (2015) (p-value = 0.018). Direct standardization − based on European standard population and results of nationwide Hungarian census of 2011 − revealed that age standardized prevalence was 105.2/100,000 (2010), which has grown to 127.2/100,000 (2015) (p-value = 0.000001). Age standardized incidence rate declined from 6.7/100,000 (2010) to 5.1/100,000 (2015) (p-value = 0.016). The ratio of MS-patients receiving ≥1 prescription for disease modifying treatment increased from 0.19 (2010) to 0.29 (2015) (p-value = 0.0051). The female/male ratio of prevalent cases remained 2.6.DiscussionThe prevalence of MS in Hungary is higher than previously reported, the incidence rate is moderate. The prevalence is rising, the incidence rate shows decline. The proportion of patients receiving disease modifying treatment grows but was still around 30% in 2015.
Highlights
Multiple sclerosis (MS) is a chronic, inflammatory disease of the central nervous system, affecting mostly young adults and possibly leading to irreversible physical, psychical and cognitive disability with a negative impact on quality of life and productivity of patients
According to worldwide estimates of the Multiple Sclerosis International Federation and the World Health Organisation published in Atlas of MS 2013 [2, 3], it affects 2.3 million individuals worldwide and around 690,000 in Europe
The Atlas states that substantial inequalities exist among regions and countries regarding the access to neurological care, magnetic resonance imaging and disease-modifying treatment
Summary
Multiple sclerosis (MS) is a chronic, inflammatory disease of the central nervous system, affecting mostly young adults and possibly leading to irreversible physical, psychical and cognitive disability with a negative impact on quality of life and productivity of patients. After traumatic injury, it is the second most common cause of permanent disability in young adults [1]. According to worldwide estimates of the Multiple Sclerosis International Federation and the World Health Organisation published in Atlas of MS 2013 [2, 3], it affects 2.3 million individuals worldwide and around 690,000 in Europe. Continuous treatment and complex management of MS is a burden for the health care system and caregivers as well [5, 6] and in the era of upcoming expensive immunomodulatory drugs, optimal allocation and planning of healthcare resources require accurate data on the number of patients affected by the disease
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