title: Quantifying the relationship between increased disability and health care resource utilization, quality of life, work productivity, health care costs in patients with multiple sclerosis in the US.
abstract: Multiple sclerosis (MS) is a chronic progressive condition affecting the central nervous system. Progression of MS results in increased level of disability and most patients will eventually experience some degree of functional impairment and impaired mobility. Costs and burdens escalate as MS disability increases. However, there is a lack of recent data on the impact of MS disability on the cost and burden among patients in the US.
  
  
  
  Data for this study were drawn from a real world, cross-sectional survey undertaken between 2013 and 2014. Neurologists completed detailed patient report forms (PRF) for the most recent consulting patients with MS (age >18 years). Patient's perceptions of their diagnosis and health-related quality of life (HRQoL) were collected through a patient self-completion questionnaire (PSC). Regression analysis was used to evaluate the relationship between disability (determined by latest Expanded Disability Status Scale [EDSS] score) and current relapse and health care resource utilization, health care costs, HRQoL and work productivity.
  
  
  
  PRF data were collected for 715 patients (335 also completed a PSC). Patients with higher disability scores (EDSS 3-5 and >5 vs <3 points) and current relapse (vs no current relapse) reported significantly greater health resource utilization for physician visits (p < 0.05) and hospitalizations (p < 0.05) in the preceding 12 months. In addition, they had poorer HRQoL (p < 0.05), were significantly more likely to be unemployed (p < 0.05) and to have had to stop working due to MS (p < 0.05). They also incurred significantly higher health care related costs, including costs for physician consultations, hospitalizations and therapy (p < 0.05). The total costs of care were $51,825, $57,889 and $67,116 for EDSS < 3, EDSS 3-5 and EDSS > 5 groups, respectively; $51,692 and $58,648 for non-relapse and relapse groups, respectively.
  
  
  
  For MS patients in the US, health resource utilization and healthcare care costs increase with progression of disability. As the disability worsens, patients also exhibit diminished HRQoL and lower work productivity. There is a need for treatments that slow down or delay disability progression among MS patients.
authors.affiliation: Adelphi Real World, Adelphi Mill, Bollington, Macclesfield, Cheshire, SK10 5JB, UK. eddie.jones@adelphigroup.com.
authors.forename: E
authors.initials: E
authors.lastname: Jones
authors.affiliation: Adelphi Real World, Adelphi Mill, Bollington, Macclesfield, Cheshire, SK10 5JB, UK.
authors.forename: J
authors.initials: J
authors.lastname: Pike
authors.affiliation: Abbvie Inc., 26525 Riverwoods Blvd., Mettawa, IL, 60060, USA.
authors.forename: T
authors.initials: T
authors.lastname: Marshall
authors.affiliation: Abbvie Inc., 26525 Riverwoods Blvd., Mettawa, IL, 60060, USA.
authors.forename: X
authors.initials: X
authors.lastname: Ye
mesh_terms: D000328:Adult; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000191:economics; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014478:Unemployment / Q000706:statistics & numerical data; D014481:United States
keywords: Burden; Costs; Disability; EDSS; Health care utilization; Health-related quality of life; Multiple sclerosis; Relapse; Work productivity