Economic Burden of Multiple Sclerosis in Low- and Middle‐Income Countries: A Systematic Review

Abstract

Background Although the economic burden of multiple sclerosis (MS) in high-income countries (HICs) has been extensively studied, information on the costs of MS in low- and middle‐income countries (LMICs) remains scarce. Moreover, no review synthesizing and assessing the costs of MS in LMICs has yet been undertaken. Objective Our objective was to systematically identify and review the cost of illness (COI) of MS in LMICs to critically appraise the methodologies used, compare cost estimates across countries and by level of disease severity, and examine cost drivers. Methods We conducted a systematic literature search for original studies in English, French, and Dutch containing prevalence or incidence-based cost data of MS in LMICs. The search was conducted in MEDLINE (Ovid), PubMed, Embase (Ovid), Cochrane Library, National Health Service Economic Evaluation Database (NHS EED), Econlit, and CINAHL (EBSCO) on July 2020 without restrictions on publication date. Recommended and validated methods were used for data extraction and analysis to make the results of the COI studies comparable. Costs were adjusted to $US, year 2019 values, using the World Bank purchasing power parity and inflated using the consumer price index. Results A total of 14 studies were identified, all of which were conducted in upper-middle-income economies. Eight studies used a bottom-up approach for costing, and six used a top-down approach. Four studies used a societal perspective. The total annual cost per patient ranged between $US463 and 58,616. Costs varied across studies and countries, mainly because of differences regarding the inclusion of costs of disease-modifying therapies (DMTs), the range of cost items included, the methodological choices such as approaches used to estimate healthcare resource consumption, and the inclusion of informal care and productivity losses. Characteristics and methodologies of the included studies varied considerably, especially regarding the perspective adopted, cost data specification, and reporting of costs per severity levels. The total costs increased with greater disease severity. The cost ratios between different levels of MS severity within studies were relatively stable; costs were around 1–1.5 times higher for moderate versus mild MS and about two times higher for severe versus mild MS. MS drug costs were the main cost driver for less severe MS, whereas the proportion of direct non-medical costs and indirect costs increased with greater disease severity. Conclusion MS places a huge economic burden on healthcare systems and societies in LMICs. Methodological differences and substantial variations in terms of absolute costs were found between studies, which made comparison of studies challenging. However, the cost ratios across different levels of MS severity were similar, making comparisons between studies by disease severity feasible. Cost drivers were mainly DMTs and...

Cost-effectiveness analysis of rituximab versus natalizumab in patients with relapsing remitting multiple sclerosis

“…Direct costs of both drugs accounted for most of the costs, the largest share of which was that of purchasing the main drug (94.36 and 41.33%, respectively). In this regard, the findings of this study are consistent with those of the studies conducted in Iran by Rezaei et al [ 61 ] and Taheri et al [ 62 ], and the ones carried out abroad by Dahham et al [ 63 ], Brodszky et al [ 64 ], Garcia et al in Panama [ 65 ], and Ernstsson et al [ 66 ].…”

Virtual Reality-Based Therapy Improves Fatigue, Impact, and Quality of Life in Patients with Multiple Sclerosis. A Systematic Review with a Meta-Analysis

“…A third author (F.A.N.-E.) was consulted when a study raised doubts about its inclusion. The inclusion criteria applied were: (1) RCT or RCT pilot; (2) participants were PwMS; (3) the study design included at least two groups; (4) one group received an intervention with VR and the second group CT or NI; (5) the study aimed to assess the effect of VR on fatigue, MS-impact, or QoL; and (6) the study provided quantitative data about the variables of interest for the meta-analysis. The exclusion criterion was RCTs including different neurological diseases apart from PwMS.…”

“…Disagreements were resolved by a third researcher (F.A.N.-E.). The following data were extracted: (1) authorship, publication date, study design, country, and funding received; (2) data related to participants (number of PwMS, age and sex); (3) experimental intervention characteristics (VR therapy length in weeks, number of sessions per week, and session time in minutes); (4) type of control intervention; (5) quantitative data obtained at the post-therapy evaluation (mean and standard deviation); and (6) follow-up time (immediate or long-term). Regarding quantitative data, when a study did not provide standard deviation, we estimated this measure using standard error, interquartile range, or range, using standardized transformations according to the Cochrane Handbook for Systematic Reviews of Interventions [33] and previous studies [18].…”

“…It results in demyelination, glial reaction, and axonal loss [2]. MS is the leading cause of disability by chronic neurological disease in young adults [3], affecting more than 2.5 million people worldwide [4], with a prevalence of 36 cases per 100,000 people [5]. In Europe, MS shows a prevalence of 83 cases per 100,000 habitants, with an average annual incidence of 4.3 cases per 100,000 members of the population [6].…”

“…MS more frequently affects females, at a 3:1 ratio before puberty [7] (1:1 after menopause [8]), which has been explained as the result of a higher female predisposition to immune diseases due to chromosomal sex and hormonal susceptibility [9,10]. In recent years, increases in life expectancy have been linked to a rise in the prevalence of MS, resulting in a sizeable socio-economic burden on healthcare systems and communities, with a mean annual cost per patient between 463 USD and 58,616 USD [5].…”