Modelling the impact of multiple sclerosis on life expectancy, quality-adjusted life years and total lifetime costs: Evidence from Australia

Abstract

Objectives: To quantify life expectancy (LE), quality-adjusted life years (QALYs) and total lifetime societal costs for a hypothetical cohort of Australians with multiple sclerosis (MS). Methods: A 4-state Markov model simulated progression from no/mild to moderate and severe disability and death for a cohort of 35-year-old women over a lifetime horizon. Death risks were calculated from Australian life tables, adjusted by disability severity. State-dependent relapse probabilities and associated disutilities were considered. Probabilities of MS progression and relapse were estimated from AusLong and TasMSL MS epidemiological databases. Annual societal (direct and indirect) costs (2017 Australian dollars) and health-state utilities for each state were derived from the Australian MS Longitudinal Study. Costs were discounted at 5% annually. Results: Mean (95% confidence interval (CI)) LE from age 35 years was 42.7 (41.6–43.8) years. This was 7.5 years less than the general Australian population. Undiscounted QALYs were 28.2 (26.3–30.0), a loss of 13.1 QALYs versus the Australian population. Discounted lifetime costs were $942,754 ($347,856–$2,820,219). Conclusion: We have developed a health economics model of the progression of MS, calculating the impact of MS on LE, QALYs and lifetime costs in Australia. It will form the basis for future cost-effectiveness analyses of interventions for MS.

Comparison of Unenhanced and Gadolinium-Enhanced Imaging in Multiple Sclerosis: Is Contrast Needed for Routine Follow-Up MRI?

“…Total lesion burden on 2D-FLAIR and 3D-DIR was classified as mild (<10), moderate (11-20), and severe (>20 or confluent). This decision was made on the basis of the proposed contextual template for MS followup MR imaging by Mamlouk et al 19 The number and locations (cortical/juxtacortical, deep, periventricular, and infratentorial) of enhancing lesions was documented on the basis of 3D postcontrast T1-weighted MPRAGE, and whether these enhancing lesions were detectable on 3D-DIR or 2D-FLAIR by expert visual assessment was determined. For MR imaging examinations with a prior comparison (eg, if the patient had completed >1 examination during the study period), the reviewers also recorded the development of interval new lesions on each of the 3 sequences and whether this new lesion was seen on only 1 sequence or all of them.…”

“…10 This use is especially timely given growing concerns about deposition of free gadolinium in the brain and other organs after using gadolinium-based contrast agents. [14][15][16] Furthermore, MS commonly affects populations 20-40 years of age 17 with approximately 40 years of life expectancy, 18 which translates into these patients undergoing >40 MR imaging examinations over the course of their disease.…”

Do people with multiple sclerosis receive appropriate support from the National Disability Insurance Scheme matching their level of disability? A description of disease ‘burden and societal cost in people with multiple sclerosis in Australia’ (BAC-MS)

“…8 In highly disabled patients, mortality is eight-fold higher than in the general population. 9 Life expectancy, in contrast, is only reduced by ,7 years, 9,10 which often translates into decades of dependency. Although the societal impact of MS in Australia has been reported, 11 these estimates omit the NDISspecific costs.…”

The Clinical Effectiveness and Cost-Effectiveness of Rituximab Versus Natalizumab in Patients With Relapsing Remitting Multiple Sclerosis

“…The time horizon in this study was the lifespan and the interval of the annual Markov cycles. For each one-year cycle in the model, the patients remained in their current states or were transferred to other ones, and any patient might experience relapse or death (23,24). All the probabilities of transition to other states, Annualized Relapse Rate, and the probability of death in each Expanded Disability Status Scale (EDSS) were extracted based on previously published studies and were presented in Table 1 1 (25)(26)(27)(28).…”