Abstract
Neuromuscular disorders (NMD) are chronic devastating diseases. The aim of this multicenter cross-sectional study was to evaluate the socioeconomic impact of three NMDs in Germany. Patients (n = 107) with amyotrophic lateral sclerosis (ALS), myasthenia gravis (MG) or facioscapulohumeral muscular dystrophy (FSHD) were recruited consecutively in seven centers in Germany. The health-economic data were collected using a “bottom-up” approach consisting of comprehensive questionnaires and patient diaries. Costs were evaluated from the societal perspective in 2009 Euros (EUR). Total annual costs from the societal perspective were EUR 36,380 (95% CI 27,090–47,970) per patient in ALS, EUR 26,240 (95% CI 17,770–37,940) in FSHD and EUR 14,950 (95% CI 10,470–21,730) in MG. The main components of costs were the expenditures of health insurance and the loss of productivity of patients and their caregivers. The following independent cost-driving factors were identified: disease severity, assistance in activities of daily living (ADL), dementia and younger age in ALS, disease severity in FSHD and assistance in ADL, disease severity and assistance in ADL in MG. The socioeconomic burden of NMDs in Germany is considerable. Further studies evaluating both the health-economic and clinical effects of NMD treatment as well as disease management programs and benchmarking activities are necessary.
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References
Barber JA, Thompson SG (2000) Analysis of cost data in randomized trials: an application of the non-parametric bootstrap. Stat Med 19:3219–3236
Brooks BR (1994) El Escorial World Federation of Neurology criteria for the diagnosis of amyotrophic lateral sclerosis. Subcommittee on motor neuron diseases/amyotrophic lateral sclerosis of the World Federation of Neurology Research Group on Neuromuscular Diseases and the El Escorial “Clinical limits of amyotrophic lateral sclerosis” workshop contributors. J Neurol Sci 124:96–107
Carpenter J, Bithell J (2000) Bootstrap confidence intervals: when, which, what? A practical guide for medical statisticians. Stat Med 19:1141–1164
Christensen PB, Jensen TS, Tsiropoulos I, Sorensen T, Kjaer M, Hojer-Pedersen E, Rasmussen MJ, Lehfeldt E, de Fine Olivarius B (1993) Incidence and prevalence of myasthenia gravis in western Denmark: 1975 to 1989. Neurology 43:1779–1783
Efron B, Tibshirani RJ (1993) An introduction to the bootstrap. Chapman and Hall, London
Emanuel EJ, Emanuel LL (1994) The economics of dying. The illusion of cost savings at the end of life. N Engl J Med 330:540–544
Federal Statistical Office of Germany. http://www.destatis.de. (accessed 15 December 2008)
Federal Statistical Office of Germany http://www.destatis.de (accessed 20 May 2009)
Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198
German Diagnosis Related Groups (G-DRG) http://www.g-drg.de (accessed 15 December 2008)
Gold MR, Siegel JE, Russell LB, Weinstein MC (1996) Cost-effectiveness in health and medicine. Oxford University Press, New York
Gray AM (1998) ALS/MND and the perspective of health economics. J Neurol Sci 160:2–5
Hamer HM, Spottke A, Aletsee C, Knake S, Reis J, Strzelczyk A, Oertel WH, Rosenow F, Dodel R (2006) Direct and indirect costs of refractory epilepsy in a tertiary epilepsy center in Germany. Epilepsia 47:2165–2172
Hillel AD, Miller RM, Yorkston K, McDonald E, Norris FH, Konikow N (1989) Amyotrophic lateral sclerosis severity scale. Neuroepidemiology 8:142–150
Institute for Quality and Efficiency in Health Care (IQWIG) Methods for Assessment of the Relation of Benefits to Costs in the German Statutory Health Care System—Version 2.0, http://www.iqwig.de/methods.805.en.html. (accessed 20 May 2009)
Jaretzki A, Barohn RJ, Ernstoff RM, Kaminski HJ, Keesey JC, Penn AS, Sanders DB (2000) Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Neurology 55:16–23
Klein LM, Forshew DA (1996) The economic impact of ALS. Neurology 47:126–129
Kobelt G, Berg J, Atherley D, Hadjimichael O, Joensson B (2004) Costs and quality of life in multiple sclerosis—a Cross-Sectional Study in the USA. SSE/EFI Working Paper Series in Economics and Finance No 594
Kobelt G, Berg J, Atherly D, Hadjimichael O (2006) Costs and quality of life in multiple sclerosis: a cross-sectional study in the United States. Neurology 66:1696–1702
Kobelt G, Berg J, Lindgren P, Berger K, Elias WG, Flachenecker P, Freidel M, Koenig N, Limmroth V, Straube E (2006) Costs and quality of life of multiple sclerosis in Germany. Eur J Health Econ 7:34–44
Krauth C, Hessel F, Hansmeier T, Wasem J, Seitz R, Schweikert B (2005) Empirical standard costs for health economic evaluation in Germany—a proposal by the working group methods in health economic evaluation. Gesundheitswesen 67:736–746
Kurtzke JF (1982) Epidemiology of amyotrophic lateral sclerosis. Adv Neurol 36:281–302
Lopez-Bastida J, Perestelo-Perez L, Monton-Alvarez F, Serrano-Aquilar P, Luis Alfonso-Sanchez J (2008) Social economic costs and health-related quality of life in patients with amyotrophic lateral sclerosis in Spain. Amyotroph Later Scler 26:1–7
Lopez-Bastida J, Serrano-Aguilar P, Perestelo-Perez L, Oliva-Moreno J (2006) Social-economic costs and quality of life of Alzheimer disease in the Canary Islands, Spain. Neurology 67:2186–2191
Lunt PW, Harper PS (1991) Genetic counselling in facioscapulohumeral muscular dystrophy. J Med Genet 28:655–664
Meltzer D, Johannesson M (1999) Inconsistencies in the “societal perspective” on costs of the panel on cost-effectiveness in health and medicine. Med Decis Making 19:371–377
Moss AH, Oppenheimer EA, Casey P, Cazzolli PA, Roos RP, Stocking CB, Siegler M (1996) Patients with amyotrophic lateral sclerosis receiving long-term mechanical ventilation. Advance care planning and outcomes. Chest 110:249–255
Negrini D, Kettle A, Sheppard L, Mills GH, Edbrooke DL (2004) The cost of a hospital ward in Europe: is there a methodology available to accurately measure the costs? J Health Org Manag 18:195–206
OECD Purchasing Power Parities (PPPs) for OECD Countries 1980–2007: OECD. 2008. http://www.oecd.org/dataoecd/61/56/39653523.xls (accessed 15 Mai 2008)
Official German doctor’s fee scale (Einheitlicher Bewertungsmasstab) (2006) Deutscher Aerzteverlag, Koeln
Orrell RW, Tawil R, Forrester J, Kissel JT, Mendell JR, Figlewicz DA (1999) Definitive molecular diagnosis of facioscapulohumeral dystrophy. Neurology 52:1822–1826
Schöffski O, Graf von der Schulenburg J-M (2007) Health-economic evaluations. (Gesundheitsökonomische Evaluationen.). Springer, Berlin
Siegel JE, Torrance GW, Russell LB, Luce BR, Weinstein MC, Gold MR (1997) Guidelines for pharmacoeconomic studies. Recommendations from the panel on cost effectiveness in health and medicine. Panel on cost Effectiveness in Health and Medicine. Pharmacoeconomics 11:159–168
Spottke AE, Reuter M, Machat O, Bornschein B, von Campenhausen S, Berger K, Koehne-Volland R, Rieke J, Simonow A, Brandstaedter D, Siebert U, Oertel WH, Ulm G, Dodel R (2005) Cost of illness and its predictors for Parkinson’s disease in Germany. Pharmacoeconomics 23:817–836
Swinyard CA, Deaver GC, Greenspan L (1957) Gradients of functional ability of importance in rehabilitation of patients with progressive muscular and neuromuscular diseases. Arch Phys Med Rehabil 38:574–579
Tarricone R (2006) Cost-of-illness analysis. What room in health economics? Health Policy 77:51–63
Tavakoli M, Malek M (2001) The cost utility analysis of riluzole for the treatment of amyotrophic lateral sclerosis in the UK. J Neurol Sci 191:95–102
The Federal Ministry for Health and Social Secure http://www.bmg.bund.de
The Federation of German Pharmaceutical Industry (2006) Rote Liste. Rote Liste Verlag, Weinheim
The German Federal Ministry of Justice http://www.bmj.bund.de (assessed 20 February 2009)
Van Der Steen I, Van Den Berg JP, Buskens E, Lindeman E, Van Den Berg LH (2009) The costs of amyotrophic lateral sclerosis, according to type of care. Amyotroph Lateral Scler May 10(1):27–34
Winter Y, Wolfram C, Schöffski O, Dodel RC, Back T (2008) Long-term disease-related costs 4 years after stroke or TIA in Germany. Nervenarzt 79:918–926
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This study was sponsored by the German Society for Muscle Disorders (Deutsche Gesellschaft für Muskelkranke).
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Schepelmann, K., Winter, Y., Spottke, A.E. et al. Socioeconomic burden of amyotrophic lateral sclerosis, myasthenia gravis and facioscapulohumeral muscular dystrophy. J Neurol 257, 15–23 (2010). https://doi.org/10.1007/s00415-009-5256-6
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DOI: https://doi.org/10.1007/s00415-009-5256-6