Abstract: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 2… Show more
“…Our initial search, conducted on 5 October 2019, retrieved 1099 records, of which only 11 articles [ 43 – 53 ] were deemed eligible. The COI study conducted in Russia was reported in two articles [ 13 , 47 ], and we excluded the article that presented the results of 16 mostly high-income European countries [ 13 ].…”
Section: Resultsmentioning
confidence: 99%
“…Backward and forward reference searching found no additional studies. As categorized according to the method for calculating costs of MS, eight of the 14 identified studies used a BU approach [ 43 – 48 , 54 , 55 ], and six used a TD approach [ 49 – 53 , 56 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Table 1 summarizes the characteristics of included studies. They were conducted in ten countries: six in Latin America (Argentina [ 43 ], Colombia [ 50 ], Mexico [ 53 ], and three studies in Brazil [ 44 , 48 , 49 ]), seven in Asia (Turkey [ 45 ], Thailand [ 54 ], Jordan [ 51 ], two studies in Iran [ 46 , 55 ], and two studies in China [ 52 , 56 ]), and one in Russia [ 47 ]. All included studies were published between 2013 and July 2020 and reported on data collected between 2000 and 2018.…”
Section: Resultsmentioning
confidence: 99%
“…The percentage of females included varied between 57.0% [ 51 ] and 78.7% [ 44 ]. The definition of MS was according to the RRMS definition [ 53 ], a combination of RRMS, secondary progressive MS, primary progressive MS [ 44 – 48 ], or the International Classification of Diseases (ICD) [ 43 , 49 – 52 , 54 , 56 ]. One study [ 55 ] did not report a definition of MS. All eight BU [ 43 – 48 , 54 , 55 ] studies reported information and costs per patient according to disease severity using the EDSS classification.…”
Section: Resultsmentioning
confidence: 99%
“…One BU study [ 46 ] did not clearly state whether costs were estimated prospectively or retrospectively; all other BU studies were clearly retrospective and reported prevalence-based COI estimates. Four BU studies used the societal perspective [ 43 , 44 , 47 , 54 ], one [ 48 ] used a household and healthcare system perspective, one [ 55 ] used a household perspective, and two [ 45 , 46 ] did not report the perspective of the analysis. All BU studies measured costs based on a questionnaire.…”
Background
Although the economic burden of multiple sclerosis (MS) in high-income countries (HICs) has been extensively studied, information on the costs of MS in low- and middle‐income countries (LMICs) remains scarce. Moreover, no review synthesizing and assessing the costs of MS in LMICs has yet been undertaken.
Objective
Our objective was to systematically identify and review the cost of illness (COI) of MS in LMICs to critically appraise the methodologies used, compare cost estimates across countries and by level of disease severity, and examine cost drivers.
Methods
We conducted a systematic literature search for original studies in English, French, and Dutch containing prevalence or incidence-based cost data of MS in LMICs. The search was conducted in MEDLINE (Ovid), PubMed, Embase (Ovid), Cochrane Library, National Health Service Economic Evaluation Database (NHS EED), Econlit, and CINAHL (EBSCO) on July 2020 without restrictions on publication date. Recommended and validated methods were used for data extraction and analysis to make the results of the COI studies comparable. Costs were adjusted to $US, year 2019 values, using the World Bank purchasing power parity and inflated using the consumer price index.
Results
A total of 14 studies were identified, all of which were conducted in upper-middle-income economies. Eight studies used a bottom-up approach for costing, and six used a top-down approach. Four studies used a societal perspective. The total annual cost per patient ranged between $US463 and 58,616. Costs varied across studies and countries, mainly because of differences regarding the inclusion of costs of disease-modifying therapies (DMTs), the range of cost items included, the methodological choices such as approaches used to estimate healthcare resource consumption, and the inclusion of informal care and productivity losses. Characteristics and methodologies of the included studies varied considerably, especially regarding the perspective adopted, cost data specification, and reporting of costs per severity levels. The total costs increased with greater disease severity. The cost ratios between different levels of MS severity within studies were relatively stable; costs were around 1–1.5 times higher for moderate versus mild MS and about two times higher for severe versus mild MS. MS drug costs were the main cost driver for less severe MS, whereas the proportion of direct non-medical costs and indirect costs increased with greater disease severity.
Conclusion
MS places a huge economic burden on healthcare systems and societies in LMICs. Methodological differences and substantial variations in terms of absolute costs were found between studies, which made comparison of studies challenging. However, the cost ratios across different levels of MS severity were similar, making comparisons between studies by disease severity feasible. Cost drivers were mainly DMTs and...
“…Our initial search, conducted on 5 October 2019, retrieved 1099 records, of which only 11 articles [ 43 – 53 ] were deemed eligible. The COI study conducted in Russia was reported in two articles [ 13 , 47 ], and we excluded the article that presented the results of 16 mostly high-income European countries [ 13 ].…”
Section: Resultsmentioning
confidence: 99%
“…Backward and forward reference searching found no additional studies. As categorized according to the method for calculating costs of MS, eight of the 14 identified studies used a BU approach [ 43 – 48 , 54 , 55 ], and six used a TD approach [ 49 – 53 , 56 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Table 1 summarizes the characteristics of included studies. They were conducted in ten countries: six in Latin America (Argentina [ 43 ], Colombia [ 50 ], Mexico [ 53 ], and three studies in Brazil [ 44 , 48 , 49 ]), seven in Asia (Turkey [ 45 ], Thailand [ 54 ], Jordan [ 51 ], two studies in Iran [ 46 , 55 ], and two studies in China [ 52 , 56 ]), and one in Russia [ 47 ]. All included studies were published between 2013 and July 2020 and reported on data collected between 2000 and 2018.…”
Section: Resultsmentioning
confidence: 99%
“…The percentage of females included varied between 57.0% [ 51 ] and 78.7% [ 44 ]. The definition of MS was according to the RRMS definition [ 53 ], a combination of RRMS, secondary progressive MS, primary progressive MS [ 44 – 48 ], or the International Classification of Diseases (ICD) [ 43 , 49 – 52 , 54 , 56 ]. One study [ 55 ] did not report a definition of MS. All eight BU [ 43 – 48 , 54 , 55 ] studies reported information and costs per patient according to disease severity using the EDSS classification.…”
Section: Resultsmentioning
confidence: 99%
“…One BU study [ 46 ] did not clearly state whether costs were estimated prospectively or retrospectively; all other BU studies were clearly retrospective and reported prevalence-based COI estimates. Four BU studies used the societal perspective [ 43 , 44 , 47 , 54 ], one [ 48 ] used a household and healthcare system perspective, one [ 55 ] used a household perspective, and two [ 45 , 46 ] did not report the perspective of the analysis. All BU studies measured costs based on a questionnaire.…”
Background
Although the economic burden of multiple sclerosis (MS) in high-income countries (HICs) has been extensively studied, information on the costs of MS in low- and middle‐income countries (LMICs) remains scarce. Moreover, no review synthesizing and assessing the costs of MS in LMICs has yet been undertaken.
Objective
Our objective was to systematically identify and review the cost of illness (COI) of MS in LMICs to critically appraise the methodologies used, compare cost estimates across countries and by level of disease severity, and examine cost drivers.
Methods
We conducted a systematic literature search for original studies in English, French, and Dutch containing prevalence or incidence-based cost data of MS in LMICs. The search was conducted in MEDLINE (Ovid), PubMed, Embase (Ovid), Cochrane Library, National Health Service Economic Evaluation Database (NHS EED), Econlit, and CINAHL (EBSCO) on July 2020 without restrictions on publication date. Recommended and validated methods were used for data extraction and analysis to make the results of the COI studies comparable. Costs were adjusted to $US, year 2019 values, using the World Bank purchasing power parity and inflated using the consumer price index.
Results
A total of 14 studies were identified, all of which were conducted in upper-middle-income economies. Eight studies used a bottom-up approach for costing, and six used a top-down approach. Four studies used a societal perspective. The total annual cost per patient ranged between $US463 and 58,616. Costs varied across studies and countries, mainly because of differences regarding the inclusion of costs of disease-modifying therapies (DMTs), the range of cost items included, the methodological choices such as approaches used to estimate healthcare resource consumption, and the inclusion of informal care and productivity losses. Characteristics and methodologies of the included studies varied considerably, especially regarding the perspective adopted, cost data specification, and reporting of costs per severity levels. The total costs increased with greater disease severity. The cost ratios between different levels of MS severity within studies were relatively stable; costs were around 1–1.5 times higher for moderate versus mild MS and about two times higher for severe versus mild MS. MS drug costs were the main cost driver for less severe MS, whereas the proportion of direct non-medical costs and indirect costs increased with greater disease severity.
Conclusion
MS places a huge economic burden on healthcare systems and societies in LMICs. Methodological differences and substantial variations in terms of absolute costs were found between studies, which made comparison of studies challenging. However, the cost ratios across different levels of MS severity were similar, making comparisons between studies by disease severity feasible. Cost drivers were mainly DMTs and...
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