title: Cost analysis of multiple sclerosis in Brazil: a cross-sectional multicenter study.
abstract: BACKGROUND
  Multiple sclerosis (MS) is a central nervous system disease associated with irreversible progression of disability, which imposes a substantial socioeconomic onus. The objective of this study was to determine the economic impact of multiple sclerosis from the Brazilian household and healthcare system perspectives. Secondary objectives were to assess the impact of fatigue on daily living and health-related quality of life (HRQL) of MS patients.
  
  
  METHODS
  This is a cross-sectional study in which Brazilian eligible patients attending eight major MS specialized sites answered an interview capturing data on demographics, disease characteristics and severity, comorbidities, resource utilization, fatigue, utilities and health-related quality of life from November/2011 to May/2012 . Costs were assessed considering a prevalence-based approach within 1 year of resource consumption and were estimated by multiplying the amount used by the corresponding unit cost. Patients were classified as having mild, moderate or severe disability according to the Expanded Disability Status Scale (EDSS).
  
  
  RESULTS
  In total, 210 patients who met eligibility criteria were included, 40 % had mild, 43 % moderate and 16 % severe disability; disability level was missing for 1 %. The average total direct cost per year was USD 19,012.32 (SD = 10,465.96), and no statistically significant differences were not observed according to MS disability level (p = 0.398). The use of disease modifying therapies (DMTs) corresponded to the majority of direct expenditures, especially among those patients with lower levels of disability, representing around 90 % of total costs for mild and moderate MS patients. It was also observed that expenses with medical (except DMTs) and non-medical resources are higher among patients with more severe disease. Worsening disability also had an important influence on health-related quality of life and self-perceived impact of fatigue on daily living.
  
  
  CONCLUSIONS
  Our data demonstrates the significant economic impact of MS on both Brazilian household and health system, in terms of DMTs and other disease management costs. When patients move upwards on the disease severity scale, costs with health resources other than drugs are significantly increased.
authors.affiliation: Novartis Biociências SA, Av. Professor Vicente Rao, 90. 04636-000, São Paulo, SP, Brazil. nilceia.lopes@novartis.com.
authors.forename: Nilceia Lopes
authors.initials: NL
authors.lastname: da Silva
authors.affiliation: ANOVA Tradução do Conhecimento em Saúde, Rio de Janeiro, RJ, Brazil.
authors.forename: Maira L S
authors.initials: MLS
authors.lastname: Takemoto
authors.affiliation: Medical School, Universidade Estadual de Campinas, Campinas, SP, Brazil.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Damasceno
authors.affiliation: Medical School, Universidade Metropolitana de Santos, Santos, SP, Brazil.
authors.forename: Yara D
authors.initials: YD
authors.lastname: Fragoso
authors.affiliation: Department of Neurology, HC de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Finkelsztejn
authors.affiliation: Hospital São Lucas da PUCRS, Porto Alegre, RS, Brazil.
authors.forename: Jefferson
authors.initials: J
authors.lastname: Becker
authors.affiliation: Hospital Regional Hans Dieter Schimidt, Joinville, SC, Brazil.
authors.forename: Marcus V M
authors.initials: MVM
authors.lastname: Gonçalves
authors.affiliation: Division of Neurology, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
authors.forename: Charles
authors.initials: C
authors.lastname: Tilbery
authors.affiliation: Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Enedina M L
authors.initials: EML
authors.lastname: de Oliveira
authors.affiliation: Hospital das Clínicas da USP, São Paulo, SP, Brazil.
authors.forename: Dagoberto
authors.initials: D
authors.lastname: Callegaro
authors.affiliation: Novartis Biociências SA, Av. Professor Vicente Rao, 90. 04636-000, São Paulo, SP, Brazil.
authors.forename: Fernanda C
authors.initials: FC
authors.lastname: Boulos
mesh_terms: D000328:Adult; D001938:Brazil; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005221:Fatigue; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006295:Health Resources; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000191:economics* / Q000628:therapy; D011788:Quality of Life
keywords: Cost analysis; Cost of illness; Multiple sclerosis; Quality of life