The Cost of MS

Ysrraelit C, et al. ENCOMS: Argentinian survey in cost of illness and unmet needs in multiple sclerosis.Arq Neuropsiquiatr. 2014;72(5):337-43.

The objective of the study was to assess the cost of multiple sclerosis (MS) patients in Argentina categorized by disease severity using a societal perspective. Method: Cross-sectional study including MS patients from 21 MS centers in 12 cities of Argentina. Patients were stratified by disease severity using the expanded disability status scale (EDSS) (group 1 with EDSS score between 0 and 3; group 2 with EDSS >3 and <7; group 3 with EDSS ≥7). Direct and indirect costs were analyzed for the second quarter of 2012 from public sources and converted to US Dollars. Results: 266 patients were included. Mean annual cost per MS patient was USD 36,025 (95%CI 31,985-38,068) for patients with an EDSS between 0-3; USD 40,705 (95%CI 37,199-46,300) for patients with EDSS >3 and <7, and USD 50,712 (95%CI 47,825-62,104) for patients with EDSS ≥7. Conclusions: This is the first Argentine study evaluating the costs of MS considering disease severity.

Fromont A, Lehanneur MN, Rollot F, Weill A, Clerc L, Bonithon Kopp C, Binquet C, Moreau T. Cost of multiple sclerosis in France. Rev Neurol (Paris). 2014 May 21. pii: S0035-3787(14)00803-0. doi: 10.1016/j.neurol.2014.02.007. [Epub ahead of print] 

Multiple sclerosis (MS) is one of the 30 chronic conditions specifically listed by the French healthcare system as a long-term disease (affections de longue durée [ALD]) for which the main health insurance fund (Caisse nationale d’assurance maladie des travailleurs salariés [CNAMTS]) provides full (100%) coverage of healthcare costs. The CNAMTS insures 87% of the French population (52,359,912 of the 60,028,292 inhabitants). The objectives of this study were to evaluate the direct and indirect medical costs of MS among the entire population insured by the CNAMTS in France in 2004. The CNAMTS provided us with access to the ALD database of patients with MS that contains different MS-related expenditures made in 2004. We calculated the overall direct and indirect cost of MS and the cost per patient and per item of expenditure. In 2004, 49,413 patients were registered on the ALD list for MS. Direct cost for MS patients was 469,719,967 €. The direct cost per patient and per year was 9,506 € with variations between regions (French administrative divisions) ranging from 10,800 € in northeastern France (Champagne-Ardenne) to 8,217 € in western France (Pays de la Loire). The different items of expenditure were treatments (44.5%), hospitalization (27.9%), nursing care (5.8%), physiotherapy (5.7%), transport (4%), biology (1.1%), and other (1.5%). During the course of the disease, the overall cost of MS increased slowly during the first 15 years (from 8,000 to 11,000 €), but dramatically the last year of life (23,410 €). The costs of immunomodulator treatments were higher during the first six years after registration on the ALD list. Conversely, physiotherapy costs increased linearly with time during the course of MS. Indirect costs were an estimated 116 million euros in 2004. A disability pension (8,918 € per patient) was perceived by 9,430 patients (19.1%) and a daily allowance (3,317 € per patient) by 9,894 patients (20%). In France, MS has an important economic impact, comparable to human immunodeficiency virus infection.

In different countries the costs of MS will vary but based on these studies you can see that with a higher EDSS or more disability then the actual costs of MS increase (even though many MSers will not be eligible/suitable for expensive DMT), So it is best to stop people getting disabled and so we should strive for NEDA (No Evident Disease Activity) as quick as possible.

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  • absolutely agree that we as a society should strive for NEDA asap… btw I read how much spending on science would be adversely affected in the UK if we (the UK) come out of the EU – I don't think the benefits of being in the EU are publicised enough… sorry to completely digress, but it is important to scientists like yourselves I imagine?

  • The use of DMTs in patients with higher EDSS seems to vary depending on a country's health care policy. Since the MS meds, which until further studies show benefit for only RRMS, are being used in SPMS/PPMS is this sound practice? From studies such as this the cost is exorbitant and may not be of benefit, except for the drug companies.

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