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Economic Burden of Multiple Sclerosis

A Systematic Review of the Literature

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Abstract

Multiple sclerosis (MS) is a disease of the CNS, typically striking adults during the primary productive time of their life. The symptoms of MS can restrict the individual’s physical activity and income-earning ability, resulting in a major financial burden on the patient, family, health system and society. This systematic literature review was conducted to document the economic burden of MS.

Employing pre-defined search terms and inclusion/exclusion criteria, systematic searches were conducted in MEDLINE, EMBASE, PsycINFO, the Health Economic Evaluations Database (HEED), the NHS Economic Evaluation Database (EED) and the UK National Institute for Health and Clinical Excellence (NICE) website as well as conference abstracts.

We identified 29 cost-of-illness studies that met the a priori inclusion criteria. The cost categories responsible for the majority of costs associated with MS varied across countries. There was a significant increase in costs associated with an increase in disease severity as measured by the Kurtzke Expanded Disability Status Scale (EDSS) score. The increase in magnitude was coupled with changes in the distribution of costs; although direct medical costs were important contributors in earlier stages of disease, they were outweighed by indirect costs in later stages, mainly due to relapses and productivity losses.

Considering the increased costs associated with relapse occurrence and increasing disease severity, pharmaceutical or non-pharmaceutical interventions aimed at delaying the progression of disease may help to reduce the economic burden of MS.

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Acknowledgements

The authors acknowledge Alissa Shaul for her assistance in the study identification and selection phase of writing this manuscript, and Julia Green for her help in validating the data extraction. Ms Shaul and Ms Green are both employees of the United BioSource Corporation.

This study was sponsored by Eli Lilly and Company. J. Birt and A. Duhig are full-time employees of Eli Lilly and Company. J. Birt owns stock in Eli Lilly and Company. H. Naci and R. Fleurence are employees of the United BioSource Corporation who were paid consultants to Eli Lilly and Company in connection with the development of this systematic review and manuscript.

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Authors and Affiliations

  1. Center for Health Economics & Science Policy, United BioSource Corporation, 20 Bloomsbury Square, London, WC1A 2NS, UK

    Huseyin Naci

  2. Center for Health Economics & Science Policy, United BioSource Corporation, Bethesda, Maryland, USA

    Rachael Fleurence

  3. Global Health Outcomes, Eli Lilly and Company, Indianapolis, Indiana, USA

    Julie Birt

Authors
  1. Huseyin Naci
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  2. Rachael Fleurence
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  3. Julie Birt
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  4. Amy Duhig
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Corresponding author

Correspondence to Huseyin Naci.

Appendix

Appendix

Search Limits and Terms

1. Search limits

  1. i.

    1993 to 25 July 2009

2. Search terms

  1. i.

    Burden of illness

  2. ii.

    Costs

  3. iii.

    Cost-benefit

  4. iv.

    Cost utility

  5. v.

    Cost-effectiveness

  6. vi.

    Cost of illness

  7. vii.

    Charges

  8. viii.

    Economics

  9. ix.

    Expenditure

  10. x.

    Quality-adjusted life years

  11. xi.

    Resource utilization

  12. xii.

    Models

  13. xiii.

    Decision — analysis

  14. xiv.

    Multiple sclerosis

  15. xv.

    Myelitis, transverse

  16. xvi.

    Demyelinating diseases

  17. xvii.

    Encephalomyelitis

  18. xviii.

    Devic

  19. xix.

    Neuromyelitis optica

  20. xx.

    Myelooptic neuropathy

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Naci, H., Fleurence, R., Birt, J. et al. Economic Burden of Multiple Sclerosis. Pharmacoeconomics 28, 363–379 (2010). https://doi.org/10.2165/11532230-000000000-00000

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