Skip to main content
SpringerLink
Log in

Direct and Indirect Economic Consequences of Multiple Sclerosis in Ireland

  • Original Research Article
  • Published:
Applied Health Economics and Health Policy Aims and scope Submit manuscript

Abstract

Introduction

Multiple sclerosis (MS) has significant financial consequences for healthcare systems, individual patients and households, and the wider society. This study examines the distribution of MS costs and resource utilisation across cost categories and from various perspectives, as MS disability increases.

Methods

Two hundred and fourteen patients with MS were recruited from a specialist MS outpatient clinic in Ireland and included in an interview-based study on MS-related healthcare resource consumption and costs. Patients were grouped into three categories based on disability: mild [Expanded Disability Status Scale (EDSS) score 0–3.5, n = 114], moderate (EDSS 4.0–6.5, n = 72) and severe (EDSS 7.0–9.5, n = 27). The mean annual direct and indirect costs (in year 2012 values) were estimated using non-parametric bootstrapping.

Results

Participants were 66.4 % female, with a mean age of 47.6 years and a mean EDSS score of 3.6. The majority had relapsing-remitting MS (RRMS) (53 %). The mean annual direct (indirect) costs per person were €10,249 (€9,447), €13,045 (€31,806) and €56,528 (€39,440) in mild, moderate and severe MS, respectively. Direct costs are driven by the cost of disease-modifying therapies and professional home help in mild and severe MS, respectively. Between 74 % (severe MS) and 96 % (mild MS) of all direct costs are borne by the healthcare payer, the remainder being incurred by patients, their families or other non-healthcare organisations.

Conclusions

MS is associated with high levels of healthcare resource consumption and costs, and these costs increase with increasing disability. There is potential to significantly reduce the economic burden of MS through interventions that prevent progression from mild or moderate MS to severe MS, help support independent living at home and keep people with MS in the work force.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Tremlett H, Zhao Y, Rieckmann P, Hutchinson M. New perspectives in the natural history of multiple sclerosis. Neurology. 2010;74(24):2004–15.

    Article  PubMed  Google Scholar 

  2. Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. Neurology. 1996;46(4):907–11.

    Article  CAS  PubMed  Google Scholar 

  3. WHO and MSIF, Atlas: multiple sclerosis resources in the world. London: Multiple Sclerosis International Federation, 2008. Available at: http://www.msif.org/en/about_msif/what_we_do/atlas_of_ms/index.html. Accessed 31 July 2013.

  4. Lonergan R, Kinsella K, Fitzpatrick P, Brady J, Murray B, Dunne C, et al. Multiple sclerosis prevalence in Ireland: relationship to vitamin D status and HLA genotype. J Neurol Neurosurg Psychiatry. 2011;82(3):317–22. doi:10.1136/jnnp.2010.220988.

    Article  CAS  PubMed  Google Scholar 

  5. Fogarty E, Walsh C, Adams R, McGuigan C, Barry M, Tubridy N. Relating health-related quality of life to disability progression in multiple sclerosis, using the 5-level EQ-5D. Mult Scler. 2013. doi:10.1177/1352458512474860.

  6. Beer S, Khan F, Kesselring J. Rehabilitation interventions in multiple sclerosis: an overview. J Neurol. 2012;259(9):1994–2008.

    Article  PubMed  Google Scholar 

  7. Weinshenker BG, Bass B, Rice GPA, Noseworthy J, Carriere W, Baskerville J, et al. The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability. Brain. 1989;112(1):133–46.

    Article  PubMed  Google Scholar 

  8. Karampampa K, Gustavsson A, Miltenburger C, Eckert B. Treatment experience, burden and unmet needs (TRIBUNE) in MS study: results from five European countries. Mult Scler. 2012;18(2 Suppl):7–15.

    Article  PubMed  Google Scholar 

  9. Kobelt G, Berg J, Atherly D, Hadjimichael O. Costs and quality of life in multiple sclerosis: a cross-sectional study in the United States. Neurology. 2006;66(11):1696–702.

    Article  PubMed  Google Scholar 

  10. McCrone P, Heslin M, Knapp M, Bull P, Thompson A. Multiple sclerosis in the UK: service use, costs, quality of life and disability. Pharmacoeconomics. 2008;26(10):847–60.

    Article  PubMed  Google Scholar 

  11. Kobelt G, Berg J, Lindgren P, Fredrikson S, Jonsson B. Costs and quality of life of patients with multiple sclerosis in Europe. J Neurol Neurosurg Psychiatry. 2006;77(8):918–26.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Casado V, Martinez-Yelamos S, Martinez-Yelamos A, Carmona O, Alonso L, Romero L et al. Direct and indirect costs of multiple sclerosis in Baix Llobregat (Catalonia, Spain), according to disability. BMC Health Services Research. 2006;6.

  13. Blahova Dusankova J, Kalincik T, Dolezal T, Kobelt G, Havrdova E. Cost of multiple sclerosis in the Czech Republic: the COMS study. Mult Scler. 2012;18(5):662–8.

    Article  CAS  PubMed  Google Scholar 

  14. Kappos L, Polman CH, Freedman MS, Edan G, Hartung HP, Miller DH, et al. Treatment with interferon beta-1b delays conversion to clinically definite and McDonald MS in patients with clinically isolated syndromes. Neurology. 2006;67(7):1242–9.

    Article  CAS  PubMed  Google Scholar 

  15. Jacobs LD, Beck RW, Simon JH, Kinkel RP, Brownscheidle CM, Murray TJ, et al. Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. N Eng J Med. 2000;343(13):898–904.

    Article  CAS  Google Scholar 

  16. Comi G, Martinelli V, Rodegher M, Moiola L, Bajenaru O, Carra A, et al. Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome (PreCISe study): a randomised, double-blind, placebo-controlled trial. Lancet Neurology. 2009;374(9700):1503–11.

    Article  CAS  Google Scholar 

  17. Comi G, Filippi M, Barkhof F, Durelli L, Edan G, Fernandez O, et al. Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study. Lancet. 2001;357(9268):1576–82.

    Article  CAS  PubMed  Google Scholar 

  18. Beecham J, Knapp M. Costing psychiatric interventions. In: Thornicroft G, editor. Measuring mental health needs. 2nd ed. London: Gaskell; 2001.

    Google Scholar 

  19. Clarke PM, Fiebig DG, Gerdtham UG. Optimal recall length in survey design. J Health Econ. 2008;27(5):1275–84.

    Article  PubMed  Google Scholar 

  20. Department of Finance (An Roinn Airgeadais) Ireland. Test discount rate. 2010. Available at: http://www.finance.gov.ie/viewdoc.asp?DocID=5387. Accessed 31 July 2013.

  21. Central Statistics Office. Earnings and labour costs. Ireland: Central Statistics Office; 2013.

  22. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an Expanded Disability Status Scale (EDSS). Neurology. 1983;33(11):1444–52.

    Article  CAS  PubMed  Google Scholar 

  23. The Multiple Sclerosis Society of Ireland. http://www.ms-society.ie/pages/living-with-ms. Accessed 31 July 2014.

  24. Health Service Executive Primary Care Reimbursement Service (HSE-PCRS). Statistical analysis of claims and payments 2011. Dublin 2012.

  25. Association of British Neurologists. Revised (2009) Association of British neurologists’ guidelines for prescribing in multiple sclerosis. London; 2009.

  26. Goodin DS, Frohman EM, Garmany GP Jr, Halper J, Likosky WH, Lublin FD, et al. Disease modifying therapies in multiple sclerosis: report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology and the MS council for clinical practice guidelines. Neurology. 2002;58(2):169–78.

    Article  CAS  PubMed  Google Scholar 

  27. Larg A, Moss JR. Cost-of-illness studies: a guide to critical evaluation. Pharmacoeconomics. 2011;29(8):653–71.

    Article  PubMed  Google Scholar 

  28. Rotstein DL, Mamdani M, O’Connor PW. Increasing use of disease modifying drugs for MS in Canada. Can J Neurol Sci. 2010;37(3):383–8.

    PubMed  Google Scholar 

  29. Goodin DS, Jones J, Li D, Traboulsee A, Reder AT, Beckmann K, et al. Establishing long-term efficacy in chronic disease: use of recursive partitioning and propensity score adjustment to estimate outcome in MS. PLoS One. 2011;6(11):e22444.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Shirani A, Zhao Y, Karim ME, Evans C, Kingwell E, Van Der Kop ML, et al. Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis. JAMA J Am Med Assoc. 2012;308(3):247–56.

    Article  CAS  Google Scholar 

  31. Karampampa K, Gustavsson A, van Munster ET, Hupperts RM, Sanders EA, Mostert J et al. Treatment experience, burden, and unmet needs (TRIBUNE) in multiple sclerosis study: the costs and utilities of MS patients in The Netherlands. J Med Econ. 2013. doi:10.3111/13696998.2013.807267.

  32. OECD Average Annual Wages. 2011. Available at: http://stats.oecd.org/Index.aspx?DataSetCode=AV_AN_WAGE. Accessed 13 June 2013.

  33. Health Service Executive (HSE) Casemix Unit: ready reckoner of acute hospital inpatient activity and costs (summarised by DRG) relating to 2010 costs and activity. 2012.

  34. Nursing home support scheme cost of care in public nursing homes. 2011. Available at: http://www.hse.ie/eng/services/list/4/olderpeople/nhss/costhse.pdf. Accessed 13 June 2013.

  35. Nursing homes support scheme maximum agreed prices with private and voluntary nursing homes. 2012. Available at: http://www.irishnursinghomes.ie/CostofCarePrivateandVoluntaryNursingHomes.pdf. Accessed 13 June 2013.

  36. Madden D, Nolan A, Nolan B. GP reimbursement and visiting behaviour in Ireland. Health Econ. 2005;14(10):1047–60. doi:10.1002/hec.995.

    Article  PubMed  Google Scholar 

  37. Consolidated salary scales in accordance with financial emergency measures in the public interest (No. 2) Act 2009 (No. 41 of 2009). Available at: http://www.hse.ie/eng/staff/Benefits_Services/pay/Payscalesjan2010.pdf. Accessed 13 June 2013.

  38. Primary care reimbursement service. Reimbursable items. http://www.sspcrs.ie/druglist/search.jsp. Accessed 13 June 2013.

Download references

Acknowledgments

We have no conflicts of interest. No funding was received for this study.

Author contributions

The study was conceptualised and initiated by EF. All authors contributed to the study design. Data acquisition was conducted by EF, NT and CMcG. EF and CW performed the study analyses. EF drafted the manuscript. All authors contributed to revisions of the manuscript and critically revised the manuscript for intellectual content. EF is the guarantor for the overall content.

Author information

Authors and Affiliations

  1. National Centre for Pharmacoeconomics, St James’s Hospital, Dublin 8, Ireland

    Emer Fogarty & Michael Barry

  2. Department of Statistics, Trinity College Dublin, Dublin, Ireland

    Cathal Walsh

  3. Department of Neurology, St. Vincent’s University Hospital, Dublin, Ireland

    Christopher McGuigan & Niall Tubridy

Authors
  1. Emer Fogarty
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cathal Walsh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christopher McGuigan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Niall Tubridy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Barry
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emer Fogarty.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 26 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fogarty, E., Walsh, C., McGuigan, C. et al. Direct and Indirect Economic Consequences of Multiple Sclerosis in Ireland. Appl Health Econ Health Policy 12, 635–645 (2014). https://doi.org/10.1007/s40258-014-0128-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40258-014-0128-3

Keywords

Search

Navigation