Economic costs associated with an MS relapse
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.
References (29)
- et al.
Long-term cost-effectiveness model of interferon beta-1b in the early treatment of multiple sclerosis in the United States
Clin Ther
(2012) - et al.
Direct and indirect cost burden associated with multiple sclerosis relapses: excess costs of persons with MS and their spouse caregivers
J Neurol Sci
(2013) - Guidelines for the Economic Evaluation of Health Technologies in Ireland,...
- et al.
Natural history of multiple sclerosis: a unifying concept
Brain
(2006) - et al.
Oligodeoxyribonucleotide probe accessibility on a three-dimensional DNA microarray surface and the effect of hybridization time on the accuracy of expression ratios
BMC Biotechnol
(2003) - et al.
Analysis of clinical outcomes according to original treatment groups 16 years after the pivotal IFNB-1b trial
J Neurol Neurosurg Psychiatry
(2010) Resource use and economic consequences associated with multiple sclerosis
Mult Scler
(2013)- et al.
Contribution of relapses to disability in multiple sclerosis
J Neurol
(2008) Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. The IFNB Multiple Sclerosis Study Group
Neurology
(1993)- et al.
Intramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis. The Multiple Sclerosis Collaborative Research Group (MSCRG)
Ann Neurol
(1996)
Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of a phase III multicenter, double-blind placebo-controlled trial. The Copolymer 1 Multiple Sclerosis Study Group
Neurology
Treatment experience, burden and unmet needs (TRIBUNE) in MS study: results from five European countries
Mult Scler
Treatment experience, burden, and unmet needs (TRIBUNE) in multiple sclerosis: the costs and utilities of MS patients in Canada
J Popul Ther Clin Pharmacol
Treatment experience, burden, and unmet needs (TRIBUNE) in Multiple Sclerosis study: the costs and utilities of MS patients in The Netherlands
J Med Econ
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National Centre for Pharmacoeconomics, Dublin, Ireland.