Impact of Mobility Impairment on Indirect Costs and Health-Related Quality of Life in Multiple Sclerosis

Abstract

This study was conducted to estimate the indirect costs and health-related quality of life (HRQoL) (utilities) of multiple sclerosis (MS) patients in the United States (US), and to determine the impact of worsening mobility on these parameters. In collaboration with the North American Research Committee on Multiple Sclerosis (NARCOMS) registry we conducted a cross-sectional study of participants who completed the biannual update and supplemental spring 2010 survey. Demographic, employment status, income, mobility impairment, and health utility data were collected from a sample of registry participants who met the study criteria and agreed to participate in the supplemental Mobility Study. Mean annual indirect costs per participant in 2011US$ and mean utilities for the population and for cohorts reporting different levels of mobility impairment were estimated. Analyses included 3,484 to 3,611 participants, based on survey completeness. Thirty-seven percent of registrants were not working or attending school and 46.7% of these reported retiring early. Indirect costs per participant per year, not including informal caregiver cost, were estimated at $30,601±31,184. The largest relative increase in indirect costs occurred at earlier mobility impairment stages, regardless of the measure used. Participants’ mean utility score (0.73±0.18) was lower than that of a similarly aged sample from the general US population (0.87). As with indirect costs, larger decrements in utility were seen at earlier mobility impairment stages. These results suggest that mobility impairment may contribute to increases in indirect costs and declines in HRQoL in MS patients.

The Clinical Meaning of Walking Speed as Measured by the Timed 25-Foot Walk in Patients With Multiple Sclerosis

“…Increased severity of patient-reported walking and mobility problems was associated with worsening health status assessed using the EuroQol 5-Dimension Index and the Hamburg Quality of Life Questionnaire in multiple sclerosis. 27,28 An indirect analysis using EDSS scores as a bridge 29 showed that slower walking speed was associated with lower health utility scores in patients with MS. In addition, patient-perceived reductions in walking speed, assessed using responses to item 10 on the Multiple Sclerosis Impact Scale, were associated with reduced HRQOL as assessed using the EuroQol 5-Dimension Index and the 12-Item Short Form Health Survey.…”

The payer’s perspective: What is the burden of MS and how should the patient’s perspective be integrated in health technology assessment conducted for taking decisions on access to care and treatment?

“…18 A US study in around 3,500 MS patients from the NARCOMS registry has also shown larger decrements in EQ-5D utility at earlier mobility impairment stages, as measured with the Patient Determined Disease Steps questionnaire. 20 A systematic literature review by Naci et al 3 in 2010 including 18 studies evaluating the correlation between disability and health utility confirmed this as well.…”

“…Interestingly, the relative contribution of sick leave and early retirement is the greatest in patients with moderate disability, as more patients are at working age in this group than in the severely disabled patient group. 20,23 Therefore, early drug and non-drug interventions which delay disability progression may help to reduce the cost burden. 3 A large amount of data on the cost of MS is available from countries across the world, but the general picture may still be confusing, as comparisons of costs are not straightforward.…”

Assessment of Upper Extremity Function in Multiple Sclerosis: Review and Opinion

“…[1][2][3] Walking impairment is a hallmark symptom of MS that has been reported in up to 90% of people with MS, and it engenders increased financial costs and patient burdens. 4,5 Although dysfunction of the upper limbs is also common, its importance is under-recognized relative to walking impairment. Therefore, the purpose of this article is to create greater recognition of this impairment in individuals with MS by reviewing its magnitude and highlighting barriers to its assessment.…”