title: Economic burden in a German cohort of patients with multiple sclerosis.
abstract: OBJECTIVE
  To estimate costs of multiple sclerosis (MS) in a German cohort according to severity of the disease and clinical symptoms.
  
  
  METHODS
  144 patients were recruited from an MS outpatient clinic. Costs were calculated according to current German health-economic guidelines from the perspective of the social health insurance system. Patients were either interviewed or completed a questionnaire. Cost assessment covered a 3-month period. Health outcomes were: Expanded Disability Status Scale, MS Functional Composite, Functional Assessment of MS, fatigue, depression (Beck Depression Inventory II) and patients' socioeconomic status. Multivariate linear regression identified independent cost predictors.
  
  
  RESULTS
  Total quarterly costs per patient were EUR 10,329 (95% CI 9,357-11,390). Direct costs were EUR 5,344 for the social health insurance system and EUR 140 for the patient. Drugs represented the major share of direct costs (and 35% of total costs); indirect costs accounted for 47% of total costs. Univariate and multivariate analyses identified age, disability, fatigue and depression as independent predictors for total, indirect or drug costs.
  
  
  CONCLUSIONS
  MS represents a high economic burden, with direct costs exceeding indirect costs. To reduce costs, research should focus on prevention that slows down progression of MS. Rehabilitation and symptomatic treatment may have merits in decreasing indirect costs.
authors.affiliation: Department of Neurology, Neurological Therapy Research Group, Philipps-University Marburg, Marburg, Germany.
authors.forename: Jens Peter
authors.initials: JP
authors.lastname: Reese
authors.forename: Axel
authors.initials: A
authors.lastname: John
authors.forename: Gabriele
authors.initials: G
authors.lastname: Wienemann
authors.forename: Anne
authors.initials: A
authors.lastname: Wellek
authors.forename: Norbert
authors.initials: N
authors.lastname: Sommer
authors.forename: Björn
authors.initials: B
authors.lastname: Tackenberg
authors.forename: Monika
authors.initials: M
authors.lastname: Balzer-Geldsetzer
authors.forename: Richard
authors.initials: R
authors.lastname: Dodel
mesh_terms: D000328:Adult; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000191:economics*