The socioeconomic impact of disability progression in multiple sclerosis: A retrospective cohort study of the German NeuroTransData (NTD) registry

Abstract

Background Multiple sclerosis (MS) is a progressively debilitating neurologic disease that poses significant costs to the healthcare system and workforce. Objective To evaluate the impact of MS disease progression on societal costs and quality of life (QoL) using data from the German NeuroTransData (NTD) MS registry. Methods Cross-sectional cohort study. The cost cohort included patients with MS disability assessed using Expanded Disability Status Scale (EDSS) in 2019 while the QoL cohort included patients assessed using EDSS and EuroQol-5 Dimension 5-Levels between 2009 and 2019. Direct and indirect medical, and non-medical resource use was quantified and costs derived from public sources. Results Within the QoL cohort ( n = 9821), QoL worsened with increasing EDSS. Within the cost cohort ( n = 7286), increasing resource use with increasing EDSS was observed. Societal costs per patient, excluding or including disease-modifying therapies, increased from €5694 or €19,315 at EDSS 0 to 3.5 to €25,419 or €36,499 at EDSS 4 to 6.5, and €52,883 or €58,576 at EDSS 7 to 9.5. In multivariate modeling, each 0.5-step increase in EDSS was significantly associated with increasing costs, and worsening QoL. Conclusion This study confirms the major socioeconomic burden associated with MS disability progression. From a socioeconomic perspective, delaying disability progression may benefit patients and society.

Polypharmacy in patients with multiple sclerosis and the impact on levels of care and therapy units

“…In addition to DMD decreasing disease activity, persisting symptoms of MS such as pain (7), paresthesias, coordination disorders (8), spasticity (9), fatigue (10), and depression (11) also often necessitate symptomatic drug treatment (SD) or non-drug treatments such as physiotherapy and occupational therapy (12).…”

“…Disease-related costs can be divided into direct costs, e.g., due to medication and hospitalization, and indirect costs, e.g., due to the loss of ability to work, with all costs associated with disease-related disability increasing in MS (29)(30)(31). The average annual societal cost per patient in Europe is 40.000e, but recent German data reveal that non-medical direct costs such as community services and informal care, as well as indirect costs due to long-term absence, invalidity, and early retirement, are the main causes of increased costs, especially for patients with a higher degree of disability (8).…”

“…Cumulative disability in MS patients also leads to an increasing dependence on family or caregivers and an increased need for care requirements (8). In Germany, the costs are partly financed via the respective level of care (LOC).…”