title: [Cost of multiple sclerosis in France].
abstract: Multiple sclerosis (MS) is one of the 30 chronic conditions specifically listed by the French healthcare system as a long-term disease (affections de longue durée [ALD]) for which the main health insurance fund (Caisse nationale d'assurance maladie des travailleurs salariés [CNAMTS]) provides full (100%) coverage of healthcare costs. The CNAMTS insures 87% of the French population (52,359,912 of the 60,028,292 inhabitants). The objectives of this study were to evaluate the direct and indirect medical costs of MS among the entire population insured by the CNAMTS in France in 2004. The CNAMTS provided us with access to the ALD database of patients with MS that contains different MS-related expenditures made in 2004. We calculated the overall direct and indirect cost of MS and the cost per patient and per item of expenditure. In 2004, 49,413 patients were registered on the ALD list for MS. Direct cost for MS patients was 469,719,967 €. The direct cost per patient and per year was 9,506 € with variations between regions (French administrative divisions) ranging from 10,800 € in northeastern France (Champagne-Ardenne) to 8,217 € in western France (Pays de la Loire). The different items of expenditure were treatments (44.5%), hospitalization (27.9%), nursing care (5.8%), physiotherapy (5.7%), transport (4%), biology (1.1%), and other (1.5%). During the course of the disease, the overall cost of MS increased slowly during the first 15 years (from 8,000 to 11,000 €), but dramatically the last year of life (23,410 €). The costs of immunomodulator treatments were higher during the first six years after registration on the ALD list. Conversely, physiotherapy costs increased linearly with time during the course of MS. Indirect costs were an estimated 116 million euros in 2004. A disability pension (8,918 € per patient) was perceived by 9,430 patients (19.1%) and a daily allowance (3,317 € per patient) by 9,894 patients (20%). In France, MS has an important economic impact, comparable to human immunodeficiency virus infection.
authors.affiliation: Service de neurologie, CHU de Dijon, 3, rue du Faubourg-Raines, 21000 Dijon, France; EA 4184, centre d'épidémiologie des populations, 1, boulevard Jeanne-d'Arc, BP 1542, 21079 Dijon, France.
authors.forename: A
authors.initials: A
authors.lastname: Fromont
authors.affiliation: Maison départementale des solidarités, service de protection maternelle et infantile (PMI), 21, rue de l'Ermitage, 71240 Sennecey-le-Grand, France.
authors.forename: M-N
authors.initials: MN
authors.lastname: Lehanneur
authors.affiliation: Inserm, CIE1, 7, boulevard Jeanne-d'Arc, 21079 Dijon, France; Centre d'investigation clinique - Épidémiologie clinique/essais thérapeutiques, université de Bourgogne, CHU de Dijon, Bocage Sud, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Rollot
authors.affiliation: CNAMTS, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France.
authors.forename: A
authors.initials: A
authors.lastname: Weill
authors.affiliation: CNAMTS, direction du service médical, 38, rue de Cracovie, 21075 Dijon cedex, France.
authors.forename: L
authors.initials: L
authors.lastname: Clerc
authors.affiliation: Inserm, CIE1, 7, boulevard Jeanne-d'Arc, 21079 Dijon, France; Centre d'investigation clinique - Épidémiologie clinique/essais thérapeutiques, université de Bourgogne, CHU de Dijon, Bocage Sud, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Bonithon Kopp
authors.affiliation: Inserm, CIE1, 7, boulevard Jeanne-d'Arc, 21079 Dijon, France; Centre d'investigation clinique - Épidémiologie clinique/essais thérapeutiques, université de Bourgogne, CHU de Dijon, Bocage Sud, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Binquet
authors.affiliation: Service de neurologie, CHU de Dijon, 3, rue du Faubourg-Raines, 21000 Dijon, France; EA 4184, centre d'épidémiologie des populations, 1, boulevard Jeanne-d'Arc, BP 1542, 21079 Dijon, France. Electronic address: thibault.moreau@CHU-dijon.fr.
authors.forename: T
authors.initials: T
authors.lastname: Moreau
mesh_terms: D000328:Adult; D019411:Clinical Laboratory Techniques / Q000191:economics; D016527:Drug Costs; D004471:Economics, Nursing; D004864:Equipment and Supplies / Q000191:economics; D005260:Female; D005602:France / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000191:economics* / Q000453:epidemiology; D009313:National Health Programs / Q000191:economics*; D010415:Pensions / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000191:economics; D012042:Registries; D014186:Transportation / Q000191:economics
keywords: Coût direct; Coût indirect; Direct cost; Indirect cost; Multiple sclerosis; Sclérose en plaques