title: Direct and indirect economic consequences of multiple sclerosis in Ireland.
abstract: BACKGROUND
  Multiple sclerosis (MS) has significant financial consequences for healthcare systems, individual patients and households, and the wider society. This study examines the distribution of MS costs and resource utilisation across cost categories and from various perspectives, as MS disability increases.
  
  
  METHODS
  Two hundred and fourteen patients with MS were recruited from a specialist MS outpatient clinic in Ireland and included in an interview-based study on MS-related healthcare resource consumption and costs. Patients were grouped into three categories based on disability: mild [Expanded Disability Status Scale (EDSS) score 0-3.5, n = 114], moderate (EDSS 4.0-6.5, n = 72) and severe (EDSS 7.0-9.5, n = 27). The mean annual direct and indirect costs (in year 2012 values) were estimated using non-parametric bootstrapping.
  
  
  RESULTS
  Participants were 66.4 % female, with a mean age of 47.6 years and a mean EDSS score of 3.6. The majority had relapsing-remitting MS (RRMS) (53 %). The mean annual direct (indirect) costs per person were €10,249 (€9,447), €13,045 (€31,806) and €56,528 (€39,440) in mild, moderate and severe MS, respectively. Direct costs are driven by the cost of disease-modifying therapies and professional home help in mild and severe MS, respectively. Between 74 % (severe MS) and 96 % (mild MS) of all direct costs are borne by the healthcare payer, the remainder being incurred by patients, their families or other non-healthcare organisations.
  
  
  CONCLUSIONS
  MS is associated with high levels of healthcare resource consumption and costs, and these costs increase with increasing disability. There is potential to significantly reduce the economic burden of MS through interventions that prevent progression from mild or moderate MS to severe MS, help support independent living at home and keep people with MS in the work force.
authors.affiliation: National Centre for Pharmacoeconomics, St James's Hospital, Dublin 8, Ireland, efogarty@stjames.ie.
authors.forename: Emer
authors.initials: E
authors.lastname: Fogarty
authors.forename: Cathal
authors.initials: C
authors.lastname: Walsh
authors.forename: Christopher
authors.initials: C
authors.lastname: McGuigan
authors.forename: Niall
authors.initials: N
authors.lastname: Tubridy
authors.forename: Michael
authors.initials: M
authors.lastname: Barry
mesh_terms: D000704:Analysis of Variance; D017281:Cost of Illness; D018450:Disease Progression; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D007407:Interviews as Topic; D007494:Ireland; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000145:classification / Q000191:economics* / Q000628:therapy; D011788:Quality of Life; D012720:Severity of Illness Index; D018434:Sickness Impact Profile