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Multiple sclerosis in Italy: cost-of-illness study

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This study estimates the direct costs of multiple sclerosis (MS) in Italy from the perspective of the National Health System. Patients diagnosed with MS for ≥1 year prior to study entry were included in the analysis; neurological disability was assessed using the Expanded Disability Status Scale (EDSS). Cost variables were analyzed according to: MS phenotype, disease course over the previous year and EDSS rating. A total of 510 patients were included in the analysis. Overall costs were significantly higher for relapsing-remitting MS and secondary progressive MS than for primary progressive MS (P < 0.05). Costs were higher for EDSS scores 0.0–3.5 and 4.0–6.0 than for scores > 6.0 (P < 0.05). The extrapolated data gave an estimated annual direct cost of MS per patient of €18,030. In conclusion, relapsing-remitting MS or secondary progressive MS phenotypes and lower estimated EDSS scores appear to be associated with higher costs.

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  1. A relapsing-remitting course was defined as the occurrence of (a) phase(s) of worsening lasting less than six months followed by phase(s) of improvement or combined improvement and inactivity lasting at least one month; or (b) phase(s) of worsening lasting less than six months followed by a plateau phase lasting at least one year; or (c) phases of worsening, each lasting less than six months and each having an onset after at least one month from the maximum worsening of the previous one; Inactive are a patient that doesn’t reveal any clinical activity within the last 6 months (d) [32].


  1. Compston A, Coles A (2002) Multiple sclerosis. Lancet 359:1221–1231

    Article  PubMed  Google Scholar 

  2. Pugliatti M, Rosati G, Carton H et al (2006) The epidemiology of multiple sclerosis in Europe. Eur J Neurol 13:700–722

    Article  PubMed  CAS  Google Scholar 

  3. Solaro C, Allemani C, Messmer Uccelli M et al (2005) The prevalence of multiple sclerosis in the north-west Italian province of Genoa. J Neurol 252:436–440

    Article  PubMed  CAS  Google Scholar 

  4. Granieri E, Malagu S, Casetta I et al (1996) Multiple sclerosis in Italy. A reappraisal of incidence and prevalence in Ferrara. Arch Neurol 53:793–798

    PubMed  CAS  Google Scholar 

  5. Totaro R, Marini C, Cialfi A, Giunta M, Carolei A (2000) Prevalence of multiple sclerosis in the L’Aquila district, central Italy. J Neurol Neurosurg Psychiatry 68:349–352

    Article  PubMed  CAS  Google Scholar 

  6. Nicoletti A, Patti F, Lo Fermo S et al (2005) Possible increasing risk of multiple sclerosis in Catania, Sicily. Neurology 65:1259–1263

    Article  PubMed  CAS  Google Scholar 

  7. Ranzato F, Perini P, Tzintzeva E et al (2003) Increasing frequency of multiple sclerosis in Padova, Italy: a 30 year epidemiological survey. Mult Scler 9:387–392

    Article  PubMed  CAS  Google Scholar 

  8. Granieri E, Casetta I, Govoni V et al (2000) The increasing incidence and prevalence of MS in a Sardinian province. Neurology 55:842–848

    PubMed  CAS  Google Scholar 

  9. Pugliatti M, Sotgiu S, Solinas G et al (2001) Multiple sclerosis epidemiology in Sardinia: evidence for a true increasing risk. Acta Neurol Scand 103:20–26

    Article  PubMed  CAS  Google Scholar 

  10. Weinshenker BG, Bass B, Rice GP et al (1989) The natural history of multiple sclerosis: a geographically based study. 2. Predictive value of the early clinical course. Brain 112:1419–1428

    Article  PubMed  Google Scholar 

  11. Richards RG, Sampson FC, Beard SM, Tappenden P (2002) A review of the natural history and epidemiology of multiple sclerosis: implications for resource allocation and health economic models. Health Technol Assess 6:1–73

    Article  PubMed  CAS  Google Scholar 

  12. Rice GPA, Kremenchutzky M, Cottrell DA (2002) Observations from the natural history cohort of London, Ontario. In: Filippi M, Comi G (eds) Topics in neuroscience: primary progressive multiple sclerosis. Springer Verlag Italia, Milano

    Google Scholar 

  13. Fattore G (1999) Clarifying the scope of Italian NHS coverage. Is it feasible? Is it desirable? Health Policy 50:123–142

    Article  PubMed  CAS  Google Scholar 

  14. Rappange DR, van Baal PH, van Exel NJ et al (2008) Unrelated medical costs in life-years gained: should they be included in economic evaluations of healthcare interventions? Pharmacoeconomics 26:815–830

    Article  PubMed  Google Scholar 

  15. Bourdette DN, Prochazka AV, Mitchell W et al (1993) Health care costs of veterans with multiple sclerosis: implications for the rehabilitation of MS. VA Multiple Sclerosis Rehabilitation Study Group. Arch Phys Med Rehabil 74:26–31

    PubMed  CAS  Google Scholar 

  16. Inman RP (1984) Disability indices, the economic costs of illness, and social insurance: the case of multiple sclerosis. Acta Neurol Scand Suppl 101:46–55

    PubMed  CAS  Google Scholar 

  17. Grudzinski AN, Hakim Z, Cox ER, Bootman JL (1999) The economics of multiple sclerosis. Distribution of costs and relationship to disease severity. Pharmacoeconomics 15:229–240

    Article  PubMed  CAS  Google Scholar 

  18. Amato MP, Battaglia MA, Caputo D et al (2002) The costs of multiple sclerosis: a cross-sectional, multicenter cost-of-illness study in Italy. J Neurol 249:152–163

    Article  PubMed  Google Scholar 

  19. Poser CM, Paty DW, Scheinberg L et al (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13:227–231

    Article  PubMed  CAS  Google Scholar 

  20. McDonald WI, Compston A, Edan G et al (2001) Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 50:121–127

    Article  PubMed  CAS  Google Scholar 

  21. Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444–1452

    PubMed  CAS  Google Scholar 

  22. Kobelt G, Berg J, Lindgren P et al (2006) Costs and quality of life of multiple sclerosis in Italy. Eur J Health Econ 7(Suppl. 2):S45–S54

    Article  PubMed  Google Scholar 

  23. Russo P, Capone A, Paolillo A et al (2004) Cost-analysis of relapsing-remitting multiple sclerosis in Italy after the introduction of new disease-modifying agents. Clin Drug Invest 24:409–420

    Article  Google Scholar 

  24. Trojano M, Pellegrini F, Fuiani A et al (2007) New natural history of interferon-beta-treated relapsing multiple sclerosis. Ann Neurol 61:300–306

    Article  PubMed  CAS  Google Scholar 

  25. Taylor B, McDonald E, Fantino B et al (2007) The cost of multiple sclerosis in Australia. J Clin Neurosci 14:532–539

    Article  PubMed  Google Scholar 

  26. Casado V, Martinez-Yelamos S, Martinez-Yelamos A et al (2006) Direct and indirect costs of Multiple Sclerosis in Baix Llobregat (Catalonia, Spain), according to disability. BMC Health Serv Res 6:143

    Article  PubMed  Google Scholar 

  27. Henriksson F, Fredrikson S, Masterman T, Jonsson B (2001) Costs, quality of life and disease severity in multiple sclerosis: a cross-sectional study in Sweden. Eur J Neurol 8:27–35

    Article  PubMed  CAS  Google Scholar 

  28. Orlewska E, Mierzejewski P, Zaborski J et al (2005) A prospective study of the financial costs of multiple sclerosis at different stages of the disease. Eur J Neurol 12:31–39

    Article  PubMed  CAS  Google Scholar 

  29. Sobocki P, Pugliatti M, Lauer K, Kobelt G (2007) Estimation of the cost of MS in Europe: extrapolations from a multinational cost study. Mult Scler 13:1054–1064

    Article  PubMed  CAS  Google Scholar 

  30. Kobelt G, Texier-Richard B, Lindgren P (2009) The long-term cost of multiple sclerosis in France and potential changes with disease-modifying interventions. Mult Scler 15:741–751

    Article  PubMed  CAS  Google Scholar 

  31. Pugliatti M, Sobocki P, Beghi E et al (2008) Cost of disorders of the brain in Italy. Neurol Sci 29:99–107

    Article  PubMed  Google Scholar 

  32. Trojano M, Avolio C, Manzari C, Calo’ A, De Robertis F, Serio G, Livrea P (1995) Multivariate analysis of predictive factors of multiple sclerosis course with a validated method to assess clinical events. J Neurol Neurosurg Psychiatry 58:300–306

    Article  PubMed  CAS  Google Scholar 

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The sponsor of the present study is Merck Serono, Italy, an affiliate of Merck KGA, Darmsdadt, Germany. Medical writing assistance was provided by Wolters Kluwer Health. This assistance was funded by Merck. Francesco Saverio Mennini discloses that the University Hospital of Catania has received research support from Bayer Schering, Biogen Idec, Merck Serono, Novartis Pharmaceuticals and Sanofi Aventis

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Correspondence to F. S. Mennini.

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Patti, F., Amato, M.P., Trojano, M. et al. Multiple sclerosis in Italy: cost-of-illness study. Neurol Sci 32, 787–794 (2011).

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