title: Burden of multiple sclerosis on direct, indirect costs and quality of life: National US estimates.
abstract: BACKGROUND
  MS imposes a significant burden on patients, caregivers, employers, and the healthcare system.
  
  
  OBJECTIVE
  To comprehensively evaluate the US MS burden using nationally representative data from the Medical Expenditure Panel Survey.
  
  
  METHODS
  We identified non-institutionalized patients aged ≥18 with MS (ICD-9 code 340) from 1998 to 2009 and compared them to individuals without an MS diagnosis (non-MS) during the interview year. The cohorts were compared using multivariate regression on direct costs, indirect costs (measured in terms of employment status, annual wages, and workdays missed), and health-related quality of life (HRQoL; measured using Short Form 12, SF-6 Dimensions, and quality-adjusted life years [QALYs]).
  
  
  RESULTS
  MS prevalence was 572,312 (95% CI: 397,004, 747,619). Annual direct costs were $24,327 higher for the MS population (n=526) vs. the non-MS population (n=270,345) (95% CI: $22,320, $26,333). MS patients had an adjusted 3.3-fold (95% CI: 2.4, 4.5) increase in the odds of not being employed vs. non-MS individuals and a 4.4-fold higher adjusted number of days in bed (95% CI 2.97, 6.45). On average, MS patients lost 10.04 QALYs vs. non-MS cohort.
  
  
  CONCLUSIONS
  MS was associated with higher healthcare costs across all components, reduced productivity due to unemployment and days spent in bed, and lower HRQoL.
authors: University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA. Electronic address: Jon.Campbell@ucdenver.edu.
authors: Jonathan D
authors: JD
authors: Campbell
authors: University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA. Electronic address: Vahram.Ghushchyan@ucdenver.edu.
authors: Vahram
authors: V
authors: Ghushchyan
authors: University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA. Electronic address: Robert.McQueen@ucdenver.edu.
authors: R
authors: R
authors: Brett McQueen
authors: Biogen Idec, Medical and Outcomes Science, Weston, MA, USA. Electronic address: sharon.cahoon-metzger@biogenidec.com.
authors: Sharon
authors: S
authors: Cahoon-Metzger
authors: Biogen Idec, Medical and Outcomes Science, Weston, MA, USA. Electronic address: terrie.pang.livingston@biogenidec.com.
authors: Terrie
authors: T
authors: Livingston
authors: University of Colorado School of Medicine, Department of Neurology, Aurora, CO, USA. Electronic address: Timothy.Vollmer@ucdenver.edu.
authors: Timothy
authors: T
authors: Vollmer
authors: University of Colorado School of Medicine, Department of Neurology, Aurora, CO, USA. Electronic address: John.Corboy@ucdenver.edu.
authors: John
authors: J
authors: Corboy
authors: University of Colorado School of Medicine, Department of Neurology, Aurora, CO, USA. Electronic address: Augusto.Miravalle@ucdenver.edu.
authors: Augusto
authors: A
authors: Miravalle
authors: University of Colorado School of Medicine, Department of Neurology, Aurora, CO, USA. Electronic address: Teri.Schreiner@ucdenver.edu.
authors: Teri
authors: T
authors: Schreiner
authors: Mastic Beach, NY, USA. Electronic address: veepjean@msn.com.
authors: Victoria
authors: V
authors: Porter
authors: University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA. Electronic address: kavita.nair@ucdenver.edu.
authors: Kavita
authors: K
authors: Nair
keywords: Burden of illness; Direct costs; MEPS; Multiple sclerosis; Quality of life; Reduced productivity