Applied Health Economics and Health Policy

, Volume 12, Issue 6, pp 635–645 | Cite as

Direct and Indirect Economic Consequences of Multiple Sclerosis in Ireland

  • Emer Fogarty
  • Cathal Walsh
  • Christopher McGuigan
  • Niall Tubridy
  • Michael Barry
Original Research Article



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.


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.


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.


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.


Multiple Sclerosis Indirect Cost Direct Cost Expand Disability Status Scale Informal Care 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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.

Supplementary material

40258_2014_128_MOESM1_ESM.docx (26 kb)
Supplementary material 1 (DOCX 26 kb)


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Emer Fogarty
    • 1
  • Cathal Walsh
    • 2
  • Christopher McGuigan
    • 3
  • Niall Tubridy
    • 3
  • Michael Barry
    • 1
  1. 1.National Centre for PharmacoeconomicsSt James’s HospitalDublin 8Ireland
  2. 2.Department of StatisticsTrinity College DublinDublinIreland
  3. 3.Department of NeurologySt. Vincent’s University HospitalDublinIreland

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