Abstract
Inequity in the availability and quality of health care services could exist between urban areas and regional/remote communities, which may have consequences for disease management costs. We aim to examine whether the cost of illness differs between people with multiple sclerosis (MS) living in regional or remote areas and those living in major cities, and what factors may explain these differences. Participants in this study come from the Economic Impact Survey (EIS) 2016 of the Australian MS Longitudinal Study (AMSLS), consisting of a baseline survey (3,163 active participants invited, 1,577 [49.9%] responded), and a cost diary (3,163 active participants invited, 488 [15.5%] responded). Remoteness was measured using the Australian Statistical Geography Standard Remoteness Structure, and classified as major cities, inner regional areas, outer regional areas, and remote/very remote areas. The overall, direct, and indirect (crude and age, sex and disease duration adjusted) costs of MS and the breakdown of these costs by key cost categories and Australian remoteness areas were calculated. Living in inner regional areas was associated with a 1.23-fold higher mean total costs compared to those living in major cities. After adjusting for age, sex and duration of MS, the mean total costs were 1.26-fold higher. The higher total costs for those living in inner regional areas seem to be driven by higher direct costs, informal care costs and indirect costs. There were no significant differences between major cities and other remoteness areas even after the multivariable adjustments. Living in more remote areas was not associated with substantially higher disease management costs among Australians with MS. Whilst costs differ between those living in inner regional areas and major cities, the differences were not large. Overall, this suggests that there are not large inequities in costs as a result of remoteness in Australians with MS.
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