title: Direct and indirect costs of Multiple Sclerosis in Baix Llobregat (Catalonia, Spain), according to disability.
abstract: BACKGROUND
  Multiple sclerosis (MS) is an incurable chronic disease that predominantly affects young adults. It has a high socio-economic impact which increases as disability progresses. An assessment of the real costs of MS may contribute to our knowledge of the disease and to treat it more efficiently. Our objective is to assess the direct and indirect costs of MS from a societal perspective, in patients monitored in our MS Unit (Baix Llobregat, Catalonia) and grouped according to their disability (EDSS).
  
  
  METHODS
  We analysed data from 200 MS patients, who answered a questionnaire on resource consumption, employment and economical status. Mean age was 41.6 years, mean EDSS 2.7, 65.5% of patients were female, 79.5% had a relapsing-remitting course, and 67.5% of them were receiving immunomodulatory treatment (IT). Patients were grouped into five EDSS stages. Data from the questionnaires, hospital charts, Catalan Health Service tariffs, and figures from Catalan Institute of Statistics were used to calculate the direct and indirect costs. The cost-of-illness method, and the human capital approach for indirect costs, were applied. Sensitivity analyses were performed to strengthen results.
  
  
  RESULTS
  The mean total annual cost of MS per patient results 24,272 euros. This cost varied according to EDSS: 14,327 euros (EDSS = 0), 18,837 euros (EDSS = 1-3), 27,870 euros (EDSS = 3.5-5.5), 41,198 euros (EDSS = 6-7) and 52,841 euros (EDSS>7.5). When the mean total annual costs was adjusted by the mean % of patients on IT in our Unit (31%) the result was 19589 euros. The key-drivers for direct costs were IT in low EDSS stages, and caregiver costs in high stages. Indirect costs were assessed in terms of the loss of productivity when patients stop working. Direct costs accounted for around 60% of total costs in all EDSS groups. IT accounts from 78% to 11% of direct costs, and decreased as disability progressed.
  
  
  CONCLUSIONS
  The total mean social costs of MS in a cohort from Baix Llobregat (Catalonia) were estimated at 24,272 euros per patient/year, and ranged between 14,327 euros (EDSS = 0) and 52,841 euros (EDSS = 7.5-9.5). Total costs, and particularly informal and direct costs, increased as the disability progressed. IT should be able to delay the progression of disability to be efficient and not only effective.
authors.affiliation: Multiple Sclerosis Unit, Institute of Biomedical Investigation, University Hospital of Bellvitge, Faculty of Medicine, Campus Bellvitge, University of Barcelona (IDIBELL), Barcelona, Spain. 31703vcr@comb.es
authors.forename: Virginia
authors.initials: V
authors.lastname: Casado
authors.forename: Sergio
authors.initials: S
authors.lastname: Martínez-Yélamos
authors.forename: Antonio
authors.initials: A
authors.lastname: Martínez-Yélamos
authors.forename: Olga
authors.initials: O
authors.lastname: Carmona
authors.forename: Lucia
authors.initials: L
authors.lastname: Alonso
authors.forename: Lucia
authors.initials: L
authors.lastname: Romero
authors.forename: Esther
authors.initials: E
authors.lastname: Moral
authors.forename: Laura
authors.initials: L
authors.lastname: Gubieras
authors.forename: Txomin
authors.initials: T
authors.lastname: Arbizu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002391:Catchment Area, Health; D017281:Cost of Illness; D004180:Direct Service Costs; D004185:Disability Evaluation; D018450:Disease Progression; D004526:Efficiency; D005260:Female; D006801:Humans; D007167:Immunotherapy; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D015995:Prevalence; D011788:Quality of Life; D018434:Sickness Impact Profile; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires