Healthcare resources utilisation in primary progressive multiple sclerosis

  • Carlo Piccinni
  • Giulia Ronconi
  • Silvia Calabria
  • Letizia Dondi
  • Emanuele Forcesi
  • Elisa Rossi
  • Antonella Pedrini
  • Nello Martini
Original Article
  • 22 Downloads

Abstract

Epidemiological data on primary progressive multiple sclerosis (PPMS) are scarce. This study was aimed to evaluate the burden of PPMS in Italy with healthcare resources utilisation and costs for Italian National Health System (INHS). A 2-year cross-sectional analysis of real-world data collected in the ARCO database, covering > 10 million Italian inhabitants, was performed. From a cohort of patients affected by MS in 2014, those supposedly affected by PPMS were defined by the concurrent matching of absence of disease-modifying treatments and use of rehabilitation services. Any other drug prescriptions, outpatient services and hospitalisations were analysed in 2015 for each subject. The average annual cost per patient was provided both for each expenditure item and by integrating these. Of 13,253,591 inhabitants, 18,453 resulted affected by MS (prevalence 139 × 100,000). Of these, 1849 agreed with additional criteria to identify PPMS (10% of MS population). The 26.8% of these experienced at least one admission in 1 year, 97.3% used at least one outpatient service and 94.3% received at least one reimbursed drug. In the perspective of INHS, PPMS generated an average annual cost of € 3783 per person: 49% for hospitalisations, 28% for outpatient services and 23% for drugs. This study provides a reliable estimation of the PPMS burden in Italy, in terms of healthcare utilisation and direct costs. These findings could be useful to estimate the changes in health expenditure following the incoming of new drugs to treat PPMS with increase of pharmaceutical cost and potential decrease of rehabilitation and hospitalisation costs.

Keywords

Primary progressive multiple sclerosis Real-world evidence Burden of disease Italy Administrative databases 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Browne P, Chandraratna D, Angood C, Tremlett H, Baker C, Taylor BV, Thompson AJ (2014) Atlas of multiple sclerosis 2013: a growing global problem with widespread inequity. Neurology 83(11):1022–1024.  https://doi.org/10.1212/wnl.0000000000000768 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Battaglia MA, Bezzini D (2017) Estimated prevalence of multiple sclerosis in Italy in 2015. Neurol Sci 38(3):473–479.  https://doi.org/10.1007/s10072-016-2801-9 CrossRefPubMedGoogle Scholar
  3. 3.
    Amato MP, Battaglia MA, Caputo D, Fattore G, Gerzeli S, Pitaro M, Reggio A, Trojano M (2002) The costs of multiple sclerosis: a cross-sectional, multicenter cost-of-illness study in Italy. J Neurol 249(2):152–163CrossRefPubMedGoogle Scholar
  4. 4.
    Kobelt G, Berg J, Lindgren P, Battaglia M, Lucioni C, Uccelli A (2006) Costs and quality of life of multiple sclerosis in Italy. Eur J Health Econ 7(Suppl 2):S45–S54.  https://doi.org/10.1007/s10198-006-0385-7 CrossRefPubMedGoogle Scholar
  5. 5.
    Karampampa K, Gustavsson A, Miltenburger C, Teruzzi C, Fattore G (2012) Treatment experience, burden and unmet needs (TRIBUNE) in MS study: results from Italy. Mult Scler 18(2 Suppl):29–34.  https://doi.org/10.1177/1352458512441566c CrossRefPubMedGoogle Scholar
  6. 6.
    Ponzio M, Gerzeli S, Brichetto G, Bezzini D, Mancardi GL, Zaratin P, Battaglia MA (2015) Economic impact of multiple sclerosis in Italy: focus on rehabilitation costs. Neurol Sci 36(2):227–234.  https://doi.org/10.1007/s10072-014-1925-z CrossRefPubMedGoogle Scholar
  7. 7.
    Battaglia M, Kobelt G, Ponzio M, Berg J, Capsa D, Dalen J (2017) New insights into the burden and costs of multiple sclerosis in Europe: results for Italy. Mult Scler 23(2_suppl):104–116.  https://doi.org/10.1177/1352458517708176 CrossRefPubMedGoogle Scholar
  8. 8.
    Olesen J, Gustavsson A, Svensson M, Wittchen HU, Jonsson B (2012) The economic cost of brain disorders in Europe. Eur J Neurol 19(1):155–162.  https://doi.org/10.1111/j.1468-1331.2011.03590.x CrossRefPubMedGoogle Scholar
  9. 9.
    Antel J, Antel S, Caramanos Z, Arnold DL, Kuhlmann T (2012) Primary progressive multiple sclerosis: part of the MS disease spectrum or separate disease entity? Acta Neuropathol 123(5):627–638.  https://doi.org/10.1007/s00401-012-0953-0 CrossRefPubMedGoogle Scholar
  10. 10.
    Miller DH, Leary SM (2007) Primary-progressive multiple sclerosis. Lancet Neurol 6(10):903–912.  https://doi.org/10.1016/s1474-4422(07)70243-0 CrossRefPubMedGoogle Scholar
  11. 11.
    Reich DS, Lucchinetti CF, Calabresi PA (2018) Multiple sclerosis. N Engl J Med 378(2):169–180.  https://doi.org/10.1056/NEJMra1401483 CrossRefPubMedGoogle Scholar
  12. 12.
    Mehr SR, Zimmerman MP (2015) Reviewing the unmet needs of patients with multiple sclerosis. Am Health Drug Benefits 8(8):426–431PubMedPubMedCentralGoogle Scholar
  13. 13.
    Holland NJ, Schneider DM, Rapp R, Kalb RC (2011) Meeting the needs of people with primary progressive multiple sclerosis, their families, and the health-care community. Int J MS Care 13(2):65–74.  https://doi.org/10.7224/1537-2073-13.2.65 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Wolinsky JS, Narayana PA, O'Connor P, Coyle PK, Ford C, Johnson K, Miller A, Pardo L, Kadosh S, Ladkani D (2007) Glatiramer acetate in primary progressive multiple sclerosis: results of a multinational, multicenter, double-blind, placebo-controlled trial. Ann Neurol 61(1):14–24.  https://doi.org/10.1002/ana.21079 CrossRefPubMedGoogle Scholar
  15. 15.
    Hawker K, O’Connor P, Freedman MS, Calabresi PA, Antel J, Simon J, Hauser S, Waubant E, Vollmer T, Panitch H, Zhang J, Chin P, Smith CH (2009) Rituximab in patients with primary progressive multiple sclerosis: results of a randomized double-blind placebo-controlled multicenter trial. Ann Neurol 66(4):460–471.  https://doi.org/10.1002/ana.21867 CrossRefPubMedGoogle Scholar
  16. 16.
    Lublin F, Miller DH, Freedman MS, Cree BAC, Wolinsky JS, Weiner H, Lubetzki C, Hartung HP, Montalban X, Uitdehaag BMJ, Merschhemke M, Li B, Putzki N, Liu FC, Haring DA, Kappos L (2016) Oral fingolimod in primary progressive multiple sclerosis (INFORMS): a phase 3, randomised, double-blind, placebo-controlled trial. Lancet 387(10023):1075–1084.  https://doi.org/10.1016/s0140-6736(15)01314-8 CrossRefPubMedGoogle Scholar
  17. 17.
    Lyon J (2018) New inroads against multiple sclerosis. JAMA 319(1):9–11.  https://doi.org/10.1001/jama.2017.14033 CrossRefPubMedGoogle Scholar
  18. 18.
    Calabria S, Cinconze E, Rossini M, Rossi E, Maggioni AP, Pedrini A, De Rosa M (2016) Adherence to alendronic or risedronic acid treatment, combined or not to calcium and vitamin D, and related determinants in Italian patients with osteoporosis. Patient Prefer Adherence 10:523–530.  https://doi.org/10.2147/ppa.s95634 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Maggioni AP, Orso F, Calabria S, Rossi E, Cinconze E, Baldasseroni S, Martini N (2016) The real-world evidence of heart failure: findings from 41 413 patients of the ARNO database. Eur J Heart Fail 18(4):402–410.  https://doi.org/10.1002/ejhf.471 CrossRefPubMedGoogle Scholar
  20. 20.
    Bargagli AM, Colais P, Agabiti N, Mayer F, Buttari F, Centonze D, Di Folco M, Filippini G, Francia A, Galgani S, Gasperini C, Giuliani M, Mirabella M, Nociti V, Pozzilli C, Davoli M (2016) Prevalence of multiple sclerosis in the Lazio region, Italy: use of an algorithm based on health information systems. J Neurol 263(4):751–759.  https://doi.org/10.1007/s00415-016-8049-8 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Bezzini D, Policardo L, Meucci G, Ulivelli M, Bartalini S, Profili F, Battaglia MA, Francesconi P (2016) Prevalence of multiple sclerosis in Tuscany (Central Italy): a study based on validated administrative data. Neuroepidemiology 46(1):37–42.  https://doi.org/10.1159/000441567 CrossRefPubMedGoogle Scholar
  22. 22.
    Koch M, Kingwell E, Rieckmann P, Tremlett H (2009) The natural history of primary progressive multiple sclerosis. Neurology 73(23):1996–2002.  https://doi.org/10.1212/WNL.0b013e3181c5b47f CrossRefPubMedGoogle Scholar
  23. 23.
    van Walraven C, Austin P (2012) Administrative database research has unique characteristics that can risk biased results. J Clin Epidemiol 65(2):126–131.  https://doi.org/10.1016/j.jclinepi.2011.08.002 CrossRefPubMedGoogle Scholar
  24. 24.
    Gini R, Schuemie MJ, Pasqua A, Carlini E, Profili F, Cricelli I, Dazzi P, Barletta V, Francesconi P, Lapi F, Donatini A, Dal Co G, Visca M, Bellentani M, Sturkenboom M, Klazinga N (2017) Monitoring compliance with standards of care for chronic diseases using healthcare administrative databases in Italy: strengths and limitations. PLoS One 12(12):e0188377.  https://doi.org/10.1371/journal.pone.0188377 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  1. 1.CORE srl—Collaborative Outcome ResearchBolognaItaly
  2. 2.Health Care DepartmentCINECA—Interuniversity ConsortiumBolognaItaly

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