title: Cost of Illness of Multiple Sclerosis - A Systematic Review.
abstract: BACKGROUND
  Cost-of-illness (COI) studies of Multiple Sclerosis (MS) are vital components for describing the economic burden of MS, and are frequently used in model studies of interventions of MS. We conducted a systematic review of studies estimating the COI of MS, to compare costs between studies and examine cost drivers, emphasizing generalizability and methodological choices.
  
  
  METHODS
  A literature search on studies published in English on COI of MS was performed in PubMed for the period January 1969 to January 2014, resulting in 1,326 publications. A mapping of studies using a bottom-up approach or top-down approach, respectively, was conducted for the 48 studies assessed as relevant. In a second analysis, the cost estimates were compared between the 29 studies that used a societal perspective on costs, human capital approach for indirect costs, presenting number of patients included, time-period studied, and year of price level used.
  
  
  RESULTS
  The mapping showed that bottom-up studies and prevalence approaches were most common. The cost ratios between different severity levels within studies were relatively stable, to the ratio of 1 to 2 to 3 for disability level categories. Drugs were the main cost drivers for MS-patients with low disease severity, representing 29% to 82% of all costs in this patient group, while the main cost components for groups with more advanced MS symptoms were production losses due to MS and informal care, together representing 17% to 67% of costs in those groups.
  
  
  CONCLUSIONS
  The bottom-up method and prevalence approach dominated in studies of COI of MS. Our findings show that there are difficulties in comparing absolute costs across studies, nevertheless, the relative costs expressed as cost ratios, comparing different severity levels, showed higher resemblance. Costs of drugs were main cost drivers for less severe MS and informal care and production losses for the most severe MS.
authors.affiliation: Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77 Stockholm, Sweden.|Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
authors.forename: Olivia
authors.initials: O
authors.lastname: Ernstsson
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
authors.forename: Hanna
authors.initials: H
authors.lastname: Gyllensten
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Alexanderson
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.|The Swedish Red Cross University College, Stockholm, Sweden.
authors.forename: Petter
authors.initials: P
authors.lastname: Tinghög
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
authors.forename: Emilie
authors.initials: E
authors.lastname: Friberg
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Norlund
mesh_terms: D017281:Cost of Illness; D006801:Humans; D009103:Multiple Sclerosis / Q000191:economics*