Variations in multiple sclerosis practice within Europe – Is it time for a new treatment guideline?

Abstract

In the past 5 years, the combination of developments in diagnostic strategy and approval of new disease-modifying therapies has provided an opportunity to achieve dramatic improvements in patient outcomes in multiple sclerosis (MS). However, across Europe there are several factors that may prevent patients from receiving the best therapy at the appropriate time, and there is variation among countries in terms of which of these factors are most relevant. Here, we review current MS clinical practices in a number of countries in the European Union to identify differences regarding initiation of treatment in patients with clinically isolated syndrome or relapsing-remitting MS, and differences in the timing of treatment switch or escalation. While recognizing that policy is not static in any country, we believe that patients' interests would be better served if a European treatment guideline was developed. Such a guideline could both inform and be informed by national policies, facilitating the dissemination of best clinical practice internationally.

Impact on healthcare resource utilization of multiple sclerosis in Spain

“…The impact on the costs of managing patients with MS is increasingly an area of interest [ 26 – 29 ]. However, comparing costs between countries with different socioeconomic, cultural, epidemiological background, and different systems for organizing and funding healthcare is very difficult [ 12 , 30 ].…”

“…These findings concur with prior studies. In a cost-of-illness analysis based on information from 1848 patients, Kobelt et al found that the total mean costs per patient were driven by the distribution of the disease severity levels [ 30 ]. Workforce participation decreased from approximately 70% in the early disease stages to less than 5% in the very late stages.…”

Multiple sclerosis registries in Europe – An updated mapping survey

“…MS patients are typically diagnosed between the ages of 20 and 50 years (4) and will in most cases be expected to live for a long time with MS (5). Although the treatment options have improved dramatically over the past decades, health care regulations and treatment strategies vary significantly between different countries (6).…”

An argument for broad use of high efficacy treatments in early multiple sclerosis

“…MS is a chronic autoimmune disorder resulting in accumulated damage to the brain, spinal cord, and optic nerves that can lead to significant neurologic disability. Two and a half decades after the first drug approval for MS, no consensus has been achieved regarding which treatments should be most often used with practices varying widely 1 and recently published international consensus guidelines differing. 2,3 Two potential treatment frameworks have been articulated.…”