Cost-of-Illness Progression Before and After Diagnosis of Multiple Sclerosis: A Nationwide Register-Based Cohort Study in Sweden of People Newly Diagnosed with Multiple Sclerosis and a Population-Based Matched Reference Group

Abstract

Background Multiple sclerosis (MS) is a chronic disease associated with increased healthcare utilisation and productivity losses.Objective The objective of this study was to explore the progression of healthcare costs and productivity losses before and after diagnosis of MS in comparison to that of a population-based matched reference group. Methods We conducted a nationwide, Swedish register-based cohort study of working-aged people with MS diagnosed in 2010-12 (n = 1988) and population-based matched references without MS (n = 7981). Nine years of observation spanned from 4 years prior (Y −4 ) to 4 years (Y +4 ) after the year of diagnosis (Y 0 ). Differences in annual all-cause healthcare costs (inpatient and specialised outpatient healthcare as well as pharmacy-dispensed prescribed drugs) and costs of productivity loss (days with sickness absence and disability pension) were estimated between the people with MS and references using t tests with 95% confidence intervals. The average excess costs of MS were estimated using generalised estimating equation models. Results People with multiple sclerosis had higher costs before the diagnosis of MS and also thereafter. The mean differences in healthcare costs and productivity losses between the people with MS and matched references in Y −4 were 216 EUR (95% confidence interval 58-374) and 1540 EUR (95% confidence interval 848-2233), with larger cost excesses observed in later study years. Summarising the 9 study years, people with MS had fivefold higher excess healthcare costs than references, and more than twice as high productivity losses. Conclusions Excess healthcare costs and productivity losses occur already before the diagnosis of MS and increase with time. The excess costs findings before diagnosis could suggest that an earlier diagnosis might lead to reduced excess costs of MS over time. Plain Language SummaryMultiple sclerosis (MS) is a neurological disease that can affect many parts of everyday life, including work. We studied the extra costs related to MS. Extra costs were defined as the difference in costs between people with MS and the general population in Sweden. To do this, we compared the costs of working-aged individuals with MS from 4 years before to 4 years after the year of MS diagnosis with those of individuals without MS. For each year, we measured the healthcare consumption and days absent owing to sickness absence or a disability pension. We found that people with MS had larger costs already before the diagnosis of MS. For all types of costs we studied, there were extra costs. The extra costs became larger with time and had a steep increase around the year of MS diagnosis. When we summarised the costs from all 9 years, people with MS had five times higher annual costs related to healthcare consumption than those without MS. There were also twice as high costs for lost production from days absent with sickness absence or a disability pension. While our data from national registers had

Excess costs of multiple sclerosis: a register-based study in Sweden

“…Our excess productivity losses of MS were larger than previous estimates from newly-diagnosed PwMS and predominately from permanent work incapacity [9]. Whereas the mean annual excess sickness absence costs around MS diagnosis were larger than observed in our prevalent cohort [9]. The excess productivity losses owing to sickness absence and disability pension reflect challenges that PwMS face to maintain work capacity and remain in or return to work.…”

“…Productivity losses increasingly outweigh the healthcare costs with worsening MS, as MS particularly affects young adults with the potential for many more years of paid work [ 7 , 66 ]. Our excess productivity losses of MS were larger than previous estimates from newly-diagnosed PwMS and predominately from permanent work incapacity [ 9 ]. Whereas the mean annual excess sickness absence costs around MS diagnosis were larger than observed in our prevalent cohort [ 9 ].…”

“…The mean excess societal costs of MS in Sweden in 2012 from healthcare consumption and productivity losses were estimated in comparison with references to be 23,507 Euros (EUR) more per person with MS (2020 values) [6]. However, population-based cost estimates from Sweden, whether the all-cause costs among people with MS (PwMS) or the costs attributable to MS, have not yet included costs from primary healthcare use as such data is not available at a national level [6][7][8][9]. This has led to underestimations.…”

Societal economic burden of multiple sclerosis and cost-effectiveness of disease-modifying therapies

“…Cost-of-illness data can also be used in a creative way, for example, to identify patients at higher risk of developing MS. This is because a recent cost comparison between 1,988 MS patients and 7,981 matched persons without MS in Sweden indicated that MS patients have higher societal costs, health care costs and costs of productivity loss during the years prior to and following diagnosis, with the cost difference increasing over time ( 35 ). Although such an approach does not replace the use of diagnostic criteria, it may serve to trace MS patients at an earlier stage.…”