Differentiating societal costs of disability worsening in multiple sclerosis

Ness, Nils-Henning; Schriefer, Dirk; Haase, Rocco; Ettle, Benjamin; Cornelissen, Christian; Ziemssen, Tjalf

doi:10.1007/s00415-019-09676-4

Cited by 39 publications

(48 citation statements)

References 26 publications

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“…For example, patients with a disease duration of < 5 years (i) had significantly higher total relapse costs compared to patients with disease durations between 5 and 10 years (j) and > 10 years (k) observed in patients with RAW for resources that are notably increased during periods of relapses (inpatient stays, physician consultations, informal care, and sick leave). This might indicate an incomplete recovery with residual disability [28,36]. This result is in line with recent findings showing the high frequency of post-relapse residual disability [37].…”

Section: Discussionsupporting

confidence: 89%

Real-World Evidence on the Societal Economic Relapse Costs in Patients with Multiple Sclerosis

et al. 2020

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Background Relapses are the hallmark of multiple sclerosis (MS). Analyses have shown that the cost of MS increases during periods of relapse. However, results are inconsistent between studies, possibly due to different study designs and the different implications of relapses with respect to patient characteristics. Objectives The aims were to estimate and describe direct and indirect relapse costs and to determine differences in costs with respect to patient characteristics. Furthermore, we describe the pharmacoeconomic impact during the relapse follow-up. Methods Data were extracted from two German, multicenter, observational studies applying a validated resource costs instrument. Relapse costs were calculated as the difference in quarterly costs between propensity score (PS)-matched patients with and without relapses (1:1 ratio). For relapse active patients, we additionally calculated the difference between quarterly costs prior to and during relapse and determined costs in the post-relapse quarter. Results Of 1882 patients, 607 (32%) presented at least one relapse. After PS-matching, 597 relapse active and relapse inactive patients were retained. Relapse costs (in 2019 values) ranged between €791 (age 50 + years) and €1910 (disease duration < 5 years). In mildly disabled and recently diagnosed patients, indirect relapse costs (range €1073-€1207) constantly outweighed direct costs (range €591-€703). The increase from prior quarter to relapse quarter was strongest for inpatient stays (+ 366%, €432; p < 0.001), day admissions (+ 228%, €57; p < 0.001), and absenteeism (127%, €463; p < 0.001). In the post-relapse quarter, direct costs and costs of absenteeism remained elevated for patients with relapse-associated worsening. Conclusion A recent diagnosis and mild disability lead to high relapse costs. The results suggest the necessity to incorporate patient characteristics when assessing relapse costs.

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Section: Discussionsupporting

confidence: 89%

Real-World Evidence on the Societal Economic Relapse Costs in Patients with Multiple Sclerosis

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“…Mainly exploratory evidence to date suggests that costs of healthcare are similar for men and women, and gender differences are small compared with the influence of relapse activity, disability accumulation, MS phenotypes, age or disease duration. 13 – 18 Consequently, relatively large samples are required to detect gender-related differences beyond the statistical noise of variability. Secondary data such as big claims databases would have sufficient power, but they do not consider costs such as unpaid home help, over-the-counter medication or presenteeism, preventing a holistic societal perspective on resource use.…”

Section: Introductionmentioning

confidence: 99%

Gender disparities in health resource utilization in patients with relapsing–remitting multiple sclerosis: a prospective longitudinal real-world study with more than 2000 patients

Schriefer¹,

Ness²,

Haase³

et al. 2020

Ther Adv Neurol Disord

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Background: For the case of multiple sclerosis, research on gender differences from a health economics perspective has not received much attention. However, cost-of-illness analyses can provide valuable information about the diverse impact of the disease and thus help decision-makers to allocate scarce resources. The aim of this study was to describe healthcare resource use and associated societal costs from a gender perspective. In particular, we aimed to identify how resource utilization potentially differs in certain cost components between men and women. Methods: Clinical and economic data were extracted from two prospective, multicentre, non-interventional, observational studies in Germany. Information on health resource use was obtained from all patients on a quarterly basis using a validated questionnaire. Cost analyses were conducted from the societal perspective including all direct (healthcare-related) and indirect (work-related) costs, regardless of who bears them. Gender-related differences were analysed by a multivariable generalized linear model with a negative binomial distribution and log link function due to the right-skewed distribution pattern of cost data. In addition, costs for men and women were descriptively analysed within subgroups of two-year disease activity. Results: In total, 2095 patients (women-to-men ratio of 2.7:1) presented a mean age of 41.85 years and a median Expanded Disability Status Scale of 2 (interquartile range 1–3.5) ( p > 0.30 for gender-related differences). Women and men did not statistically differ in total quarterly costs (€2329 ± €2570 versus €2361 ± €2612). For both, costs were higher with advancing disease severity and indirect costs were the main societal cost driver. Regarding healthcare-related resources, women incurred higher costs for ambulant consultations [incidence rate ratio (IRR) 1.16, confidence interval (CI) 1.04–1.31], complementary medicine (IRR 2.41, CI 1.14–5.06), medical consumables (IRR 2.53, CI 1.69–3.79) and informal care (IRR 2.79, CI 1.56–5.01). Among indirect costs, we found higher costs for men for presenteeism (IRR 0.62; CI 0.53–0.72) and higher costs for women for disability pension (IRR 1.62; CI 1.23–2.13). Conclusions: Multiple sclerosis poses a significant economic burden on patients, families and society. While the total economic burden did not differ between male and female patients, we found gender differences in specific cost items that are similar to those in the wider non-MS population.

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“…As a result of an optimally adjusted treatment of MS patients, disease progression can be delayed or prevented. Studies using MS-HRS displayed that delaying or preventing disease progression may reduce the societal economic burden of MS (MS-HRS is an easy administrable tool for a holistic assessment of resource utilization from a societal perspective for patients with MS) (54,55).…”

Section: Discussionmentioning

confidence: 99%

A Digital Patient Portal for Patients With Multiple Sclerosis

et al. 2020

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Background: Multiple Sclerosis is a chronic inflammatory disease of the central nervous system that requires a complex, differential, and lifelong treatment strategy, which involves high monitoring efforts and the accumulation of numerous medical data. A fast and broad availability of care, as well as patient-relevant data and a stronger integration of patients and participating care providers into the complex treatment process is desirable. The aim of the ERDF-funded project "Integrated Care Portal Multiple Sclerosis" (IBMS) was to develop a pathway-based care model and a corresponding patient portal for MS patients and health care professionals (HCPs) as a digital tool to deliver the care model. Methods: The patient portal was created according to a patient-centered design approach which involves both the patients' and the professionals' view. Buurmann's five iterative phases were integrated into a design science research process. A problem analysis focusing on functions and user interfaces was conducted through surveys and workshops with MS patients and HCPs. Based on this, the patient portal was refined and a prototype of the portal was implemented using an agile software development strategy. Results: HCPs and patients already use digital hardware and are open to new technologies. Nevertheless, they desire improved (digital) communication and coordination between care providers. Both groups require a number of functions for the patient portal, which were implemented in the prototype. Usability tests with patients and HCPs are planned to consider whether the portal is deemed as usable, acceptable as well as functional to prepare for any needed ameliorations. Discussion: After testing the patient portal for usability, acceptability, and functionality, it will most likely be a useful and high-quality electronic health (eHealth) tool for patient management from day care to telerehabilitation. It implements clinical pathways in a manner which is comprehensible for patients. Future developments of the patient portal modules could include additional diseases, the integration of quality management and privacy management tools, and the use of artificial intelligence to personalize treatment strategies.

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Differentiating societal costs of disability worsening in multiple sclerosis

Cited by 39 publications

References 26 publications

Real-World Evidence on the Societal Economic Relapse Costs in Patients with Multiple Sclerosis

Real-World Evidence on the Societal Economic Relapse Costs in Patients with Multiple Sclerosis

Gender disparities in health resource utilization in patients with relapsing–remitting multiple sclerosis: a prospective longitudinal real-world study with more than 2000 patients

A Digital Patient Portal for Patients With Multiple Sclerosis

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