title: Healthcare Costs for Treating Relapsing Multiple Sclerosis and the Risk of Progression: A Retrospective Italian Cohort Study from 2001 to 2015.
abstract: BACKGROUND
  Disease modifying treatments (DMTs) are the main responsible for direct medical costs in multiple sclerosis (MS). The current investigation aims at evaluating possible associations between healthcare costs for treating relapsing remitting MS (RRMS) and disease evolution.
  
  
  METHODS
  The present cohort study retrospectively included 544 newly diagnosed RRMS patients, prospectively followed up for 10.1±3.3 years. Costs for DMT administration and management were calculated for each year of observation. Following clinical endpoints were recorded: time to first relapse, 1-point EDSS progression, reaching of EDSS 4.0, reaching of EDSS 6.0, and conversion to secondary progressive MS (SP). Covariates for statistical analyses were age, gender, disease duration and EDSS at diagnosis.
  
  
  RESULTS
  At time varying Cox regression models, 10% increase in annual healthcare costs was associated with 1.1% reduction in 1-point EDSS progression (HR = 0.897; p = 0.018), with 0.7% reduction in reaching EDSS 6.0 (HR = 0.925; p = 0.030), and with 1.0% reduction in SP conversion (HR = 0.902; p = 0.006).
  
  
  CONCLUSIONS
  Higher healthcare costs for treating MS have been associated with a milder disease evolution after 10 years, with possible reduction of long-term non-medical direct and indirect costs.
authors.affiliation: Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy.
authors.forename: Marcello
authors.identifier: http://orcid.org/0000-0003-2613-3090
authors.initials: M
authors.lastname: Moccia
authors.affiliation: Department of Primary Care and Public Health, Imperial College, London, United Kingdom.|Department of Public Health, Federico II University, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Palladino
authors.affiliation: Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Lanzillo
authors.affiliation: Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Carotenuto
authors.affiliation: Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy.
authors.forename: Cinzia Valeria
authors.initials: CV
authors.lastname: Russo
authors.affiliation: Department of Public Health, Federico II University, Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Triassi
authors.affiliation: Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Brescia Morra
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009103:Multiple Sclerosis / Q000191:economics* / Q000473:pathology*; D012189:Retrospective Studies