This study assessed the cost to society of multiple sclerosis (MS) in Sweden in 1998. The cost-of-illness method, based on the human capital theory, was used as the theoretical framework. The study used a cross-sectional approach, in which resource utilization data and quality-of-life data (utilities) were collected at a single time point. The total cost of MS was estimated at 4868 MSEK, or 586 MEUR, giving an annual cost of 442 500 SEK, or 53 250 EUR, per patient (1USD = 9.73 SEK, 1 EUR = 8.31 SEK, as of 21 September 2000). Direct costs accounted for about 67% of total cost, and they were dominated by the cost of personal assistants and drugs. Indirect costs (loss of production) accounted for about 33% of total costs. To these economic costs, intangible costs of 2702 MSEK (325 MEUR) should be added as well. Direct, indirect and informal care costs all rose significantly with increased disability and were higher during a relapse. Quality of life declined substantially with increased disability and was lower during a relapse. Multiple sclerosis was found to be associated with much higher costs to society than has been ascertained by former studies. The study also revealed a strong correlation between severity of the disease and quality of life. These results are crucial for further studies on the cost-effectiveness of new treatments aimed at preventing relapses and reducing progression of the disease.
. Henriksson F, Agardh C‐D, Berne C, Bolinder J, Lönnqvist F, Stenström P. Östenson C‐G, Jönsson B (Centre for Health Economics, Stockholm; Department of Endocrinology, University Hospital MAS, Malmö; Department of Internal Medicine, Uppsala University Hospital; Centre for Metabolism and Endocrinology and SmithKline Beecham Pharmaceuticals AB, Karolinska Institute; Diabetes Prevention Unit, Karolinska Hospital, Stockholm, Sweden). Direct medical costs for patients with type 2 diabetes in Sweden. J Intern Med 2000; 248: 387–396. Objectives. To estimate the total direct medical costs to society for patients with type 2 diabetes in Sweden and to investigate how different factors, for example diabetic late complications, affect costs. Design. Cross‐sectional data regarding health care utilization, clinical characteristics and quality of life, were collected at a single time‐point. Data on resource use cover the 6‐month period prior to this time point. Setting. Patient recruitment and data collection were performed in nine primary care centres in three main regions in Sweden. Subjects. Only patients with an age at diabetes diagnosis ≥ 30 years (type 2 diabetes) were included (n = 777). Results. The total annual direct medical costs for the Swedish diabetes type 2 population were estimated at about 7 billion SEK (Swedish Kronor) in 1998 prices, which is about 6% of the total health care expenditures and more than four times higher than the former Swedish estimate obtained when using diabetes as main diagnosis for calculating costs. The annual per patient cost was about 25 000 SEK. The largest share of this cost was hospital inpatient care. Costs increased with diabetes duration and were higher for patients treated with insulin compared to those treated with oral hypoglycaemic drugs or with life style modification only. Patients with both macro‐ and microvascular complications had more than three times higher costs compared with patients without such complications. Conclusions. Type 2 diabetes is a serious and expensive disease and the key to reducing costs seems to be intensive management and control in order to prevent and delay the associated late complications.
This paper investigates the effects of changes in drug therapy on drug expenditure in Sweden between 1990 and 1995. Analyses have been carried out for both the aggregate drug expenditure and for drug expenditure according to the main groups of the Anatomical Therapeutic Chemical (ATC) classification system. Changes in expenditure can be divided into 3 components: the price of drugs, the quantity of drugs consumed and a residual. The size of the residual is a measure of the effect of changes in drug treatment patterns on drug expenditure. The aggregate real drug expenditure increased by 50% between 1990 and 1995. The relative retail price index of drugs decreased by 9% and the quantity index measured in terms of defined daily doses increased by 27%. The remaining residual increased by 30%. This implies that, if the residual had been unchanged during the study period, the aggregate expenditure would have increased by only 15%. The results also show that the size of the residual varies substantially across different ATC groups. The increase in the residual was largest for drugs that affect the nervous system (ATC group N); the residual increased by 86%. From the observed changes in residual values, it can be concluded that the underlying factor responsible for the increase in drug expenditure in Sweden is changes in drug therapy from less expensive to more expensive drugs.
Cost-effectiveness analysis in SPMS requires that the effect of treatment beyond clinical trials be included. Also, analysis should be done from a societal perspective, since many of the costs occur outside the healthcare system. The cost-utility ratios estimated in this analysis are at or below the mean threshold value indicated in a recent survey of health economists ($60,000).
This paper investigates the economic burden of multiple sclerosis (MS) in Sweden in 1994. The cost structure was compared with costs from a similar study from 1991 and 3 studies from the UK. The cost-of-illness method, based on the human capital theory, was used to estimate the economic burden of MS in Sweden, and a prevalence approach and a top-down method were chosen. Both direct and indirect costs were estimated. The total cost (in Swedish kronor) of MS was SEK1.736 billion1 in Sweden in 1994. The indirect costs (production losses as a result of morbidity) accounted for about 80% of the total cost. While the cost of inpatient care was substantial, the drug cost was minimal by comparison. The same cost pattern was present in 1991 in Sweden; however, since the transfer of costs for long term care to the municipalities in 1992, 95% of total cost of the disease fell outside of the healthcare sector. Similar cost structures have been shown in other studies, for example, in the UK. The cost pattern shown in this study, with low costs for medical care and drugs, reflects the fact that few treatment possibilities have existed for MS. However, new relatively expensive drugs have recently been introduced, which may alter the future cost. At present, there is uncertainty regarding how many patients will be treated and the future prices of these new drugs. The cost pattern of MS may very well change dramatically in the future, and successive cost-of-illness studies is one way to assess the consequences of the introduction of new technology.
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