Academic journal article Applied Health Economics and Health Policy

Direct and Indirect Economic Consequences of Multiple Sclerosis in Ireland

Academic journal article Applied Health Economics and Health Policy

Direct and Indirect Economic Consequences of Multiple Sclerosis in Ireland

Article excerpt

Published online: 17 September 2014

© Springer International Publishing Switzerland 2014


Introduction Multiple sclerosis (MS) has significant financial consequences for healthcare systems, individual patients and households, and the wider society. This study examines the distribution of MS costs and resource utilisation across cost categories and from various perspectives, as MS disability increases.

Methods Two hundred and fourteen patients with MS were recruited from a specialist MS outpatient clinic in Ireland and included in an interview-based study on MS-related healthcare resource consumption and costs. Patients were grouped into three categories based on disability: mild [Expanded Disability Status Scale (EDSS) score 0-3.5, n = 114], moderate (EDSS 4.0-6.5, n = 72) and severe (EDSS 7.0-9.5, n = 27). The mean annual direct and indirect costs (in year 2012 values) were estimated using non-parametric bootstrapping.

Results Participants were 66.4 % female, with a mean age of 47.6 years and a mean EDSS score of 3.6. The majority had relapsing-remitting MS (RRMS) (53 %'). The mean annual direct (indirect) costs per person were euro10,249 (euro9,447), euro13,045 (euro31,806) and euro56,528 (euro39,440) in mild, moderate and severe MS, respectively. Direct costs are driven by the cost of diseasemodifying therapies and professional home help in mild and severe MS, respectively. Between 74 % (severe MS) and 96 % (mild MS) of all direct costs are borne by the healthcare payer, the remainder being incurred by patients, their families or other non-healthcare organisations.

Conclusions MS is associated with high levels of healthcare resource consumption and costs, and these costs increase with increasing disability. There is potential to significantly reduce the economic burden of MS through interventions that prevent progression from mild or moderate MS to severe MS, help support independent living at home and keep people with MS in the work force.

1 Introduction

Multiple sclerosis (MS) is a chronic, disabling disease characterised by inflammation and multifocal demyelination in the central nervous system. The majority of patients experience an initial relapsing-remitting (RR) disease course, typically characterised by episodic loss of neurological function, followed by complete or partial recovery. This RR phase may last approximately 10-20 years, but the majority of people with initial RRMS will develop secondary progressive MS (SPMS), characterised by progressive, permanent disability, at some stage [1]. A smaller subset of patients develop primary progressive MS (PPMS), for whom progressive neurological disability occurs from onset [2]. MS is twice as common in women as in men. The estimated median global prevalence of MS is 30 people per 100,000, although significant geographical variation exists [3]. The prevalence in Ireland is between 180 and 290/100,000 [4].

The condition is associated with significant economic and health-related quality-of-life (HRQoL) burden. An unpredictable disease course can include clinical features such as pain and loss of sensation, fatigue, impaired muscle control, balance and postural problems, visual loss, cognitive impairments, and bowel and bladder disturbance. HRQoL has been shown to diminish in line with increasing physical disability [5]. Healthcare resource utilisation in MS has significant financial consequences for the healthcare system, patients and their families. During the RR phase of the disease, pharmacological and other interventions are used to treat relapses, manage symptoms, and attempt to delay disease progression. As the disease progresses, symptom management predominates, with the aim of maintaining independence and functioning both at work and at home. This often requires a complex multidisciplinary approach including inpatient, ambulatory, and home-based rehabilitation interventions under medical supervision [6]. …

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