Background:Multiple sclerosis (MS) commonly affects young adults and can be associated with significant disability resulting in considerable socioeconomic burden for both patient and society.
Aims:The aim was to determine the direct and indirect cost of an MS relapse.
Methods: This was a prospective audit composed of medical chart review and patient questionnaire. Relapses were stratified into 3 groups: low, moderate and high intensity. Age, gender, MS subtype, disease duration,expanded disability status scale (EDSS) score, disease modifying therapy (DMT) use and employment status were recorded. Direct costs included GP visits, investigations, clinic visit, consultations with medical staff, medication and admission costs. Indirect costs assessed loss of earnings, partner׳s loss of earnings, childcare, meals and travel costs.
Results: Fifty-three patients had a clinically confirmed relapse. Thirteen were of low intensity; 23 moderate intensity and 17 high intensity with mean costs of €503, €1395 and €8862, respectively. Those with high intensity episodes tended to be older with higher baseline EDSS (p<0.003) and change in EDSS (p<0.002). Direct costs were consistent in both low and moderate intensity groups but varied with length of hospital stay in the high intensity group. Loss of earnings was the biggest contributor to indirect costs. A decision to change therapy as a result of the relapse was made in 23% of cases, further adding to annual MS related costs.
Conclusions: The cost of an MS relapse is dependent on severity of the episode but even low intensity episodes can have a significant financial impact for the patient in terms of loss of earnings and for society with higher annual MS related costs.
The average cost in Ireland is €15,000 per year for first-line therapy rising to €22,000 per year for second-line agents and are a significant contributor to the direct costs early in the disease.
Greater variability was seen in indirect costs across all three groups as might be expected from the diverse demographics of a relatively small patient sample. Unsurprisingly, the main component of this figure was loss of earnings. MS typically affects young adults when they are most economically productive. High rates of early retirement on medical grounds are seen in patients with MS with significant socioeconomic consequences for the individual, their family and society as a whole.
This study showed that even low intensity episodes can have significant financial implications both for the patient, in terms of loss of income and for society, with increasing annual MS related costs due to initiation or change of treatment