title: Perspectives in multiple sclerosis health care: special focus on the costs of multiple sclerosis.
abstract: Brain disorders are amongst the leading causes of disease and disability worldwide, accounting for 35% of the burden of all diseases in Europe. Despite their enormous personal and national impact the knowledge of the financial and economic impression of brain disorders has been relatively little researched. Recently it has been estimated that there are nearly 400,000 multiple sclerosis (MS) patients in Europe, which is 0.003% of all brain disease patients in the continent. In MS economic consequences are predominantly the early loss of work capacity and the impact of physical and psychological disabilities in a population of young adults, hospitalization during severe disease exacerbations and the need for assistance in activities of daily living. In the last decade the introduction of new immunomodulatory treatments led to an increase in direct costs due to the cost of these drugs, but also led to a more intensive management of patients. However, most studies of MS costs were carried out prior to the widespread use of newer treatments. In the present study we estimated the economic impact of MS in Israel and compared the traditional-vertical management model with the integrated-multidisciplinary model of health service delivery following the introduction of immunomodulatory treatments. Mean direct health cost was 8,554 euros and 5,599 euros in the traditional and integrative models, respectively (p<0.01). After 1-year follow-up, full-time employment decreased by 10% in the traditional model and increased by 17% in the integrated model (p<0.05). Analysis of variance demonstrated that the model of service delivery explained most of the difference in cost between the two models. Compared to mean annual costs in Europe that are estimated at 23,695 euros per case the cost of health services in Israel by MS patients is significantly lower. MS represents a high economic burden to society. In line with the findings from 15 studies published in Europe, we can conclude that studies agree with the following findings: a) costs outside the healthcare system, non-medical costs and informal care dominate the costs of MS, b) costs increase with increasing severity of the disease and c) an integrated service delivery model that is satisfying to patients on the one hand and cost effective on the other is to be recommended.
authors.affiliation: Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Israel. zeevrot@013.net.il
authors.forename: Zeev
authors.initials: Z
authors.lastname: Rotstein
authors.forename: Rivka
authors.initials: R
authors.lastname: Hazan
authors.forename: Yoram
authors.initials: Y
authors.lastname: Barak
authors.forename: Anat
authors.initials: A
authors.lastname: Achiron
mesh_terms: D017281:Cost of Illness; D019033:Delivery of Health Care, Integrated / Q000191:economics*; D004651:Employment / Q000706:statistics & numerical data; D005060:Europe; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007167:Immunotherapy; D007557:Israel; D009103:Multiple Sclerosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*