Costs and quality of life of multiple sclerosis in Italy

Abstract

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.

[Cost-effectiveness analysis of delayed-release dimethyl-fumarate in the treatment of relapsing-remitting multiple sclerosis in Italy]

“…La Tabella VI riporta sinteticamente i costi annuali medi di monitoraggio per ciascuna delle alternative incluse nell'analisi. La stima del costo diretto sanitario di una ricaduta in Italia è stata effettuata a partire dai dati dello studio Kobelt [46]. Data l'assenza di un riferimento bibliografico diretto, attraverso una procedura di calcolo è stata isolata la quota di costo associata alle cure sanitarie per una ricaduta (€ 1.987) partendo dal costo sociale della ricaduta stimato nello studio Kobelt (€ 4.000).…”

[Budget impact analysis for peginterferon beta-1a in relapsing remitting multiple sclerosis in Italy]

“…Il costo varia da circa € 23.000 nei pazienti con lieve disabilità (Expanded Disability Status Scale -EDSS = 0-3), a circa € 44.000 nei pazienti con disabilità moderata (EDSS = 4-6,5), fino a circa € 63.000 nei pazienti con disabilità severa (EDSS ≥ 7) [14]. I costi diretti sanitari (fra cui: ospedalizzazioni, diagnostica, test di laboratorio, visite, farmaci) rappresentano circa il 29%, i costi indiretti (perdita di produttività: assenza dal lavoro, pensionamento anticipato) circa il 29% ed i costi diretti non sanitari (fra cui: assistenza da parte di parenti e/o amici, modifiche strutturali all'abitazione e/o all'autovettura, trasporto, sedia a rotelle, ausili per la deambulazione) circa il 42% dei costi sociali della sclerosi multipla [15]. Diverse sono le terapie in grado di modificare il decorso della malattia (Disease Modifying Therapies -DMT) riducendo il numero delle ricadute e rallentando la progressione della disabilità.…”

“…I costi di gestione delle ricadute sono stati calcolati mediante l'elaborazione dei dati di costo dello studio di Kobelt e colleghi [15] che ha stimato il costo sociale dovuto a una ricaduta in circa € 4.000, confrontando i costi trimestrali dei pazienti con ricadute rispetto a quelli dei pazienti liberi da ricadute, nel sottogruppo con EDSS < 5. Sulla base della stima complessiva dello studio Kobelt e della proporzione tra costi diretti e indiretti nello stesso studio, è stato stimato il costo diretto sanitario per la gestione di una ricaduta che è risultato pari a € 1.987.…”

Can civilian disability pensions overcome the poverty issue? A DSGE analysis for Italian data

“…In the costs of diseases analysis, evaluations of costs associated to illness are defined as social cost studies (Montanelli and Gerzeli, 2001;Amato et al, 2002;Patti et al, 2011;Leardini et al, 2002;Casado et al, 2006;Kobelt et al, 2004;Kobelt, 2006;Kobelt et al, 2006a;Kobelt et al, 2006b;Russo et al, 2004;Naci et al, 2010) 6 .…”

“…So far, social costs have been estimated using micro data with reference to specific illnesses (Amato et al, 2002;Patti et al, 2011;Leardini et al, 2002;Casado et al, 2006;Kobelt, 2006;Kobelt et al, 2006a;Kobelt et al, 2006b;Russo et al, 2004;Naci et al, 2010). As far as we know, macro data allowing a quantification of disability costs are not available.…”