Economic costs associated with an MS relapse

https://doi.org/10.1016/j.msard.2014.09.002Get rights and content

Highlights

  • Multiple sclerosis relapse costs are determined by the severity of the episode.

  • Even low intensity relapses can have significant financial implications.

  • Higher intensity episodes were associated with higher baseline disability.

  • Indirect costs were mainly attributed to loss of earnings.

  • Relapses can significantly increase annual multiple sclerosis related costs.

Abstract

Background

Multiple sclerosis (MS) commonly affects young adults and can be associated with significant disability resulting in considerable socioeconomic burden for both patient and society.

Aims

The aim was to determine the direct and indirect cost of an MS relapse.

Methods

This was a prospective audit composed of medical chart review and patient questionnaire. Relapses were stratified into 3 groups: low, moderate and high intensity. Age, gender, MS subtype, disease duration, expanded disability status scale (EDSS) score, disease modifying therapy (DMT) use and employment status were recorded. Direct costs included GP visits, investigations, clinic visit, consultations with medical staff, medication and admission costs. Indirect costs assessed loss of earnings, partner׳s loss of earnings, childcare, meals and travel costs.

Results

Fifty-three patients had a clinically confirmed relapse. Thirteen were of low intensity; 23 moderate intensity and 17 high intensity with mean costs of €503, €1395 and €8862, respectively. Those with high intensity episodes tended to be older with higher baseline EDSS (p<0.003) and change in EDSS (p<0.002). Direct costs were consistent in both low and moderate intensity groups but varied with length of hospital stay in the high intensity group. Loss of earnings was the biggest contributor to indirect costs. A decision to change therapy as a result of the relapse was made in 23% of cases, further adding to annual MS related costs.

Conclusions

The cost of an MS relapse is dependent on severity of the episode but even low intensity episodes can have a significant financial impact for the patient in terms of loss of earnings and for society with higher annual MS related costs.

Introduction

Multiple sclerosis (MS) is the most common disabling, non-traumatic neurological condition affecting young adults. In the early stages the disease follows a relapsing-remitting (RRMS) course, in which episodes of neurological dysfunction are followed by periods of recovery. However, about 50% of relapses result in increased residual disability (Hirst et al., 2008, Lublin et al., 2003) and over time the majority of patients will enter the secondary progressive phase (Confavreux and Vukusic, 2006) with significant impact on quality of life and increasing economic burden (Karampampa et al., 2012a). High relapse activity in the first two years of diagnosis are predictive of time to sustained disability, early conversion to secondary progressive MS and earlier mortality (Leray et al., 2010, Scalfari et al., 2014).

The economic cost associated with relapses and subsequent disability is considerable. Disability is assessed using the expanded disability status scale (EDSS) (Kurtzke, 1983). Scores of EDSS≤3 indicate that patients are independently mobile with minimal disability; 4–6.5 mean higher levels of disability generally with restriction of the mobility and may require an aid to walk; EDSS≥7 reflects a high level of assistance for all activities of daily living. TRIBUNE (Karampampa et al., 2012a), a multicentre study initially carried out in five European countries examined the costs associated with MS; the annual cost for those with EDSS≤3 ranged from €13,534 to €22,561 increasing to €28,524–€43,984 for EDSS 4–6.5 and €39,592–€65,395 for EDSS≥7. A similar study carried out in Ireland (Fogarty E, 2013) showed mean annual costs of €19,000, €45,000 and €95,000 for mild, moderate and severe disease, respectively.

The cost of managing a relapse is dependent on the severity of symptoms. In a recent American study (Parise et al., 2013) the mean annual costs for low or medium intensity episodes were US$9212 (€6731) and US$21,119 (€15430) for high intensity episodes. In a Canadian study (Karampampa et al., 2012b) 50% of RRMS patients with EDSS ≤5 experienced at least one relapse over the previous year with an increased cost of CA$10,512 (€6902) when compared to those who were relapse free. They estimated the mean cost of a relapse was CA$6402 (€4203) and was similar to a European multicentre study (Karampampa et al., 2012a, Karampampa et al., 2013). Both these studies however, were based on patient questionnaires, without clinical confirmation of the relapse and relapses were not stratified according to level of severity.

The aim of this audit was to prospectively determine both the direct and indirect costs associated with a clinically confirmed MS relapse of varying severity.

Section snippets

Study design

This was a prospective audit conducted over 18 months from January 2011 to June 2012 at St Vincent׳s University Hospital, Dublin, a university teaching hospital with a large secondary and tertiary referral MS service. It included a review of the medical notes and patient questionnaire.

Patients

Consecutive patients presenting, with a relapse confirmed by their treating neurologist were invited to participate. A relapse was defined as new or recurring neurological symptoms present for at least 24 h, based

Patient characteristics and relapse severity

A summary of baseline characteristics relative to each relapse is outlined in Table 1. Fifty-three clinical relapses were documented during the study period: 13 were considered low intensity; 23 moderate intensity and 17 high intensity; the differences in gender ratios between groups reflects the small sample size. Patients with high intensity relapses tended to be older with a significantly higher baseline EDSS (mean 3.6, p<0.003) than those in the low intensity group. They also had a

Discussion

The cost of an MS relapse is determined by the severity of the episode and the baseline disability level of the subject. Direct costs accounted for the majority of the low and moderate intensity episodes and were more consistent across each group compared to the high intensity group. Higher costs were driven primarily by hospital admission and length of stay. A significant increase in EDSS during the relapse was seen in the high intensity group and multifocal and spinal cord relapses were more

Conclusions

This is the first report looking at both indirect and direct costs in a clinically confirmed relapse amongst an Irish population and showed that even low intensity episodes can have significant financial implications both for the patient, in terms of loss of income and for society, with increasing annual MS related costs due to initiation or change of treatment.

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