Cost-Analysis of Relapsing-Remitting Multiple Sclerosis in Italy after the???Introduction of New Disease-Modifying Agents

Russo, Pierluigi; Capone, Alessandro; Paolillo, Andrea; Macchia, F.; Ranzato, Federica; Costantino, Gianfranco; Esposti, Luca Degli; Caprino, L.

doi:10.2165/00044011-200424070-00004

Cited by 24 publications

(13 citation statements)

References 29 publications

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“…Results from a more recent Italian study cannot be compared to our estimates [14]. This study included only patients with RRMS; 75 had an EDSS score <4 and 74 were being treated with DMDs.…”

Section: Discussionmentioning

confidence: 95%

Costs and quality of life of multiple sclerosis in Italy

Kobelt¹,

Berg²,

Lindgren³

et al. 2006

Eur J Health Econ

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This cost-of-illness analysis based on information from 921 patients in Italy is part of a Europe-wide cost-of-illness study in multiple sclerosis (MS). The objective was to analyze the costs and quality of life (QOL) related to the level of disease severity and progression. Patients registered with the Italian MS patient organization were asked to participate in a mail survey, and 31% responded. The questionnaire asked for details on the disease (type of disease, relapses, level of functional disability), information on all medical and non-medical resource consumption, and informal care and work capacity (sick leave and early retirement). In addition, patients were asked about their current QOL (in the form of utility) and the level of fatigue. The mean age of respondents was 46 years, and 8.5% were 65 years or older. As many as 20% of patients had severe disease (Expanded Disability Status Scale [EDSS] score of > or =7), 47% had moderate disease (EDSS score of 4-6.5) and only 31% had mild disease (EDSS score of 0-3). Thus, the mean EDSS score in the sample was 4.6 (median 5.0), with a utility of 0.53 (range: 0 = death to 1 = full health) and a fatigue level of 6.4 (range: 1 = not tired to 10 = extremely tired). Costs and utility are highly correlated with disease severity. Workforce participation decreases from approximately 80% in early disease to less than 10% in the very late stages. Total costs increase fivefold between an EDSS score of 0-1 and a score of 7. Health-care costs, however, show a limited increase with worsening disease--hospitalization increases from euro 800 per patient to euro 3200, and ambulatory care increases from euro 900 to euro 1500. Productivity losses, on the other hand, increase by a factor of 12, while informal care increases from euro 500 at an EDSS score of 0-1 to nearly euro 25 000 at an EDSS score of 7, and euro 39 000 at an EDSS score of 8-9. Hence, total mean costs per patient are determined essentially by the distribution of the severity levels in the sample, increasing from euro 12 000 at an EDSS score of 0-1 to euro 57 000 at an EDSS score of 7, and euro 71 000 at an EDSS score of 8-9. The same is true for utility, which decreases from 0.80 to 0.06 as the disease becomes severe. However, the utility loss compared to the age- and gender-matched general population is high at all levels of the disease, leading to an estimated annual loss of 0.3 quality-adjusted life year (QALY) per patient. Relapses for patients with an EDSS score of <5 are associated with a cost of approximately euro 4000 and a utility loss of 0.18 during the quarter in which they occur.

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Section: Discussionmentioning

confidence: 95%

Costs and quality of life of multiple sclerosis in Italy

Kobelt¹,

Berg²,

Lindgren³

et al. 2006

Eur J Health Econ

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“…In 2004, Kobelt found that in the US DMTs had begun to account for 34% of total costs per MS patient each year, and over half of all direct medical costs [11]. Similarly, an Italian 2004 study suggested that 77% of direct medical costs were attributed to DMTs [12]. On average DMTs cost $16,050 per MS-treated patient per year in 2004 dollars.…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Multiple Sclerosis Disease-Modifying Therapies: A Systematic Review of the Literature

Yamamoto

Campbell

2012

Autoimmune Diseases

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Objective. To provide a current and comprehensive understanding of the cost-effectiveness of DMTs for the treatment of MS by quantitatively evaluating the quality of recent cost-effectiveness studies and exploring how the field has progressed from past recommendations. Methods. We assessed the quality of studies that met our systematic literature search criteria using the Quality of Health Economic Studies validated instrument. Results. Of the 82 studies that met our initial search criteria, we included 22 in this review. Four studies (18%) achieved quality category 2, three studies (14%) achieved quality category 3, and 15 studies (68%) achieved the highest quality category 4. 91% of studies were simulation models. 13 studies (59%) had quality-adjusted life years (QALYs) as the primary outcome measure, included a societal perspective in the analysis, and utilized time horizons of 10 years to lifetime. Conclusions. To continue to improve the cost-effectiveness evidence of DMTs, we recommend: lifetime horizons, societal perspectives, and QALYs; supplemental evidence with shorter horizons, payer perspectives, and clinical outcomes to inform multiple decision makers; development of modeling and input standards for comparability; head-to-head RCTs between DMTs and long-term prospective studies; and comprehensive cost-effectiveness studies that compare all appropriate DMTs.

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“…Thus the findings of these cost studies may no longer be entirely accurate, since the introduction of new therapies may have changed the management of the disease in several ways. Although more recent cost studies exist, these have focused on specific subgroups of patients treated with DMDs [8,9] or have been performed outside Europe [10], and results cannot be related to the patient population in Europe.…”

Section: Introductionmentioning

confidence: 99%

Costs and quality of life in multiple sclerosis in Europe: method of assessment and analysis

Kobelt

Berg²,

Lindgren³

et al. 2006

Eur J Health Econ

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The objective of this observational study in nine European countries was to establish the current cost of MS at different levels of disease severity. The study used a prevalence-based bottom-up to estimate costs from a societal perspective. Patients were recruited via patient organizations and neurology centres and asked by mail to complete a detailed questionnaire concerning their resource consumption, work capacity, quality of life and current disease status. Resources included all health-care and social services, personal expenditures, informal care and temporary or definitive work absence. Quality of life was collected as utility and disease information collected related to functional capacity, relapses and fatigue. The data were analyzed separately for each country, using local unit costs but a fully standardized methodology. A total of 13 186 patients at all levels of disease severity participated in the survey, with an average response rate of around 40% (range 20-75%). This paper describes the methodology used for the study, while results are presented in the individual country reports.

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Cost-Analysis of Relapsing-Remitting Multiple Sclerosis in Italy after the???Introduction of New Disease-Modifying Agents

Abstract: Based on the results of this study, IFNβ treatment considerably modified the management of RRMS and was associated with a rise in cost of treatment per patient.

Cited by 24 publications

References 29 publications

Costs and quality of life of multiple sclerosis in Italy

Costs and quality of life of multiple sclerosis in Italy

Cost-Effectiveness of Multiple Sclerosis Disease-Modifying Therapies: A Systematic Review of the Literature

Costs and quality of life in multiple sclerosis in Europe: method of assessment and analysis

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