Cost analysis of multiple sclerosis in Brazil: a cross-sectional multicenter study

Abstract

BackgroundMultiple sclerosis (MS) is a central nervous system disease associated with irreversible progression of disability, which imposes a substantial socioeconomic onus. The objective of this study was to determine the economic impact of multiple sclerosis from the Brazilian household and healthcare system perspectives. Secondary objectives were to assess the impact of fatigue on daily living and health-related quality of life (HRQL) of MS patients.MethodsThis is a cross-sectional study in which Brazilian eligible patients attending eight major MS specialized sites answered an interview capturing data on demographics, disease characteristics and severity, comorbidities, resource utilization, fatigue, utilities and health-related quality of life from November/2011 to May/2012 . Costs were assessed considering a prevalence-based approach within 1 year of resource consumption and were estimated by multiplying the amount used by the corresponding unit cost. Patients were classified as having mild, moderate or severe disability according to the Expanded Disability Status Scale (EDSS).ResultsIn total, 210 patients who met eligibility criteria were included, 40 % had mild, 43 % moderate and 16 % severe disability; disability level was missing for 1 %. The average total direct cost per year was USD 19,012.32 (SD = 10,465.96), and no statistically significant differences were not observed according to MS disability level (p = 0.398). The use of disease modifying therapies (DMTs) corresponded to the majority of direct expenditures, especially among those patients with lower levels of disability, representing around 90 % of total costs for mild and moderate MS patients. It was also observed that expenses with medical (except DMTs) and non-medical resources are higher among patients with more severe disease. Worsening disability also had an important influence on health-related quality of life and self-perceived impact of fatigue on daily living.ConclusionOur data demonstrates the significant economic impact of MS on both Brazilian household and health system, in terms of DMTs and other disease management costs. When patients move upwards on the disease severity scale, costs with health resources other than drugs are significantly increased.

Fatigue and Self-management among Multiple Sclerosis Patients

“…For living situation in this study, the majority of MS patients lived with family. This finding is coherent with [26] who confirmed that 94 % of MS patients were living with family/spouse. While [25] mentioned that about half of the patients were living with families.…”

“…According to level of education, it shows that more than half of MS patients had a secondary level and less than half with bachelor level, this agreed with [25] who reported that 78% had diploma degree and below this level of literacy. In addition [26] reported that (41%) had high school level of education.…”

The economic impact of multiple sclerosis to the patients and their families in Norway

“…The costs to the patients and their families, USD 24,121 annually and USD 1,575,200 lifetime, were specified. Later, studies on the cost of MS to the patients and their families have concentrated on direct [9][10][11] or indirect [12][13][14] costs. None of the above studies, except for the United Kingdom study from 1994, included income tax effects.…”

Costs of multiple sclerosis in Panama from societal, patient perspectives and health-related quality of life

“…Information on the cost of the disease in Latin America is very limited, most studies having been performed in Brazil, Colombia and Argentina [ 5 , 27 , 28 ]. In Brazil, the annual direct cost was estimated at 19,012.32 USD (SD: 10,465.96), with no significant differences identified according to the patient’s disability [Expanded Disability Status Scale (EDSS) in mild (0–3), moderate (4–6.5) and severe MS (≥7)] [ 28 ]. In Colombia, differences were detected according to the patient’s disability, with the total cost, from the perspective of the third-party payers, for a patient EDSS 3–5.5 of 25,713 USD, and for a patient with EDSS 8–9.5 of 10,543 USD [ 29 ].…”