Healthcare, Sickness Absence, and Disability Pension Cost Trajectories in the First 5 Years After Diagnosis with Multiple Sclerosis: A Prospective Register-Based Cohort Study in Sweden

Abstract

Objectives The aim was to longitudinally explore the healthcare, sickness absence (SA), and disability pension (DP) cost trajectories among newly diagnosed people with multiple sclerosis (MS), and investigate whether trajectories differ by year of MS diagnosis, sociodemographics, and multi-morbidity. Methods People with MS in Sweden, aged 25-60 years and with a new MS diagnosis in the years 2006, 2007, 2008, or 2009 (four different cohorts) were identified in nationwide registers and followed prospectively for 5 years, determining the annual, per patient, direct (inpatient and specialised outpatient healthcare, co-payments, and dispensed drugs) and indirect (SA and DP) costs. Descriptive statistics and group-based trajectories were computed. Results In total, 3272 people with new MS were identified. In all cohorts, direct costs increased the year after diagnosis and thereafter declined (e.g. from €8261 to €9128, and to €7953, 5 years after diagnosis, for the 2006 cohort). SA costs continuously decreased over 5 years, while DP costs increased (e.g. from €9795 to €2778 vs. from €7277 to €15,989, respectively, for the 2006 cohort). When pooling all cohorts, four trajectories of direct and indirect costs were identified. A total of 32.1% of people with MS had high direct and indirect costs, which first increased and then decreased; the contrary was seen for trajectories with low direct and indirect costs. Conclusions There is heterogeneity in the development of MS costs over time after diagnosis; decreasing cost trajectories could be associated with the use of innovative MS therapies, slowing disease progression over time.

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

“…Specifically, that excess healthcare costs spike around MS diagnosis and excess productivity losses more steadily increase along the clinical course [ 12 ]. Furthermore, 63.9% of PwMS in Sweden have previously been observed to follow a similar healthcare cost trend to ours after the diagnosis of MS [ 52 ]. While our focus was on the excess between PwMS and references, previous COI studies suggest that the cost excess of MS likely differs among PwMS [ 52 ], for example, by sex [ 10 ], disability [ 15 ] or phenotype [ 53 ].…”

Association Between Physical Activity and Odds of Chronic Conditions Among Workers in Spain

“…Because chronic conditions have been identified as major causes of sickness absenteeism and disability pension (29,30), strategies should be implemented to reduce their current incidence. Our study suggests that performing the recommended amount of physical activity could be a way forward.…”

Early vs. late treatment initiation in multiple sclerosis and its impact on cost of illness: A register-based prospective cohort study in Sweden

“…All healthcare resource consumption, SA, and DP during a calendar year, were included, Inpatient and outpatient costs were calculated by multiplying the inpatient stays and outpatient visits during a calendar year, available in the NPR, with their observed nationwide weight for each diagnosisrelated group (DRG) and the national cost per 1.0 DRG point. 5 Co-payment costs were calculated from the use of inpatient stays and outpatient visits as the sum of patient fees for inpatient and outpatient healthcare during each calendar year. The reimbursement period for patient fees was assumed to start on 1 January, and co-payments were set to zero after the accumulated fees had reached the co-payment ceiling each year (see Table 1).…”

“…4 About 43% of people with MS (PwMS) who not were in paid work had quit their employment within the first three years after diagnosis. 4 In fact, productivity losses account for 65%-75% of all costs in MS, 5,6 due to elevated rates of sickness absence (SA) and/or disability pension (DP). [7][8][9] Costs for disease modifying therapies (DMTs), inpatient, and specialized outpatient care are also substantial among PwMS.…”