title: New insights into the burden and costs of multiple sclerosis in Europe.
abstract: BACKGROUND
  The current focus in multiple sclerosis (MS) is on early diagnosis and drug intervention, with a view to modifying disease progression. Consequently, healthcare costs have shifted from inpatient care and rehabilitation to outpatient care.
  
  
  OBJECTIVE
  This European burden of illness study provides data that can be combined with other evidence to assess whether management approaches provide value to society.
  
  
  METHODS
  A cross-sectional study was conducted in 16 countries. Patients reported on their disease, health-related quality of life (HRQoL) and resource consumption. Descriptive analyses were performed by disease severity. Costs are reported from a societal perspective in 2015€ PPP (adjusted for purchasing power parity).
  
  
  RESULTS
  The 16,808 participants had a mean age of 51.5 years, and 52% had relapsing-remitting multiple sclerosis (RRMS). Work capacity declined from 82% to 8%, and utility declined from normal population values to less than zero with advancing disease. Mean costs were 22,800€ PPP in mild, 37,100€ PPP in moderate and 57,500€ PPP in severe disease; healthcare accounted for 68%, 47% and 26%, respectively. Fatigue and cognitive difficulties were reported by 95% and 71% of participants, respectively; both had a significant independent effect on utility.
  
  
  CONCLUSIONS
  Costs and utility were highly correlated with disease severity, but resource consumption was heavily influenced by healthcare systems organisation and availability of services.
authors.affiliation: European Health Economics, Mulhouse, France.
authors.forename: Gisela
authors.initials: G
authors.lastname: Kobelt
authors.affiliation: Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Thompson
authors.affiliation: Mapi Group, Stockholm, Sweden.
authors.forename: Jenny
authors.initials: J
authors.lastname: Berg
authors.affiliation: Mapi Group, Stockholm, Sweden.
authors.forename: Mia
authors.initials: M
authors.lastname: Gannedahl
authors.affiliation: Mapi Group, Stockholm, Sweden.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Eriksson
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics; D017281:Cost of Illness; D018450:Disease Progression; D005060:Europe; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D011788:Quality of Life; D012008:Recurrence; D012720:Severity of Illness Index
keywords: HRQoL; Multiple sclerosis; burden of illness; cognition; costs; fatigue