title: Multiple sclerosis in Canada 2011 to 2031: results of a microsimulation modelling study of epidemiological and economic impacts.
abstract: BACKGROUND
  The objective of our study was to present model-based estimates and projections on current and future health and economic impacts of multiple sclerosis (MS) in Canada over a 20-year time horizon (2011-2031).
  
  
  METHODS
  Using Statistics Canada's Population Health Microsimulation Model (POHEM) framework, specifically the population-based longitudinal, microsimulation model named POHEM-Neurological, we identified people with MS from health administrative data sources and derived incidence and mortality rate parameters from a British Columbia population-based cohort for future MS incidence and mortality projections. We also included a utility-based measure (Health Utilities Index Mark 3) reflecting states of functional health to allow projections of health-related quality of life. Finally, we estimated caregiving parameters and health care costs from Canadian national surveys and health administrative data and included them as model parameters to assess the health and economic impact of the neurological conditions.
  
  
  RESULTS
  The number of incident MS cases is expected to rise slightly from 4051 cases in 2011 to 4794 cases per 100 000 population in 2031, and the number of Canadians affected by MS will increase from 98 385 in 2011 to 133 635 in 2031. The total per capita health care cost (excluding out-of-pocket expenses) for adults aged 20 and older in 2011 was about $16 800 for individuals with MS, and approximately $2500 for individuals without a neurological condition. Thus, after accounting for additional expenditures due to MS (excluding out-of-pocket expenses), total annual health sector costs for MS are expected to reach $2.0 billion by 2031. As well, the average out-of-pocket expenditure for people with MS was around $1300 annually throughout the projection period.
  
  
  CONCLUSIONS
  MS is associated with a significant economic burden on society, since it usually affects young adults during prime career- and family-building years. Canada has a particularly high prevalence of MS, so research such as the present study is essential to provide a better understanding of the current and future negative impacts of MS on the Canadian population, so that health care system policymakers can best plan how to meet the needs of patients who are affected by MS. These findings also suggest that identifying strategies to prevent MS and more effectively treat the disease are needed to mitigate these future impacts.
authors.affiliation: Public Health Agency of Canada, Ottawa, Ontario, Canada.
authors.forename: Nana
authors.initials: N
authors.lastname: Amankwah
authors.affiliation: Department of Internal Medicine (Neurology) and Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Marrie
authors.affiliation: Public Health Agency of Canada, Ottawa, Ontario, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Bancej
authors.affiliation: Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada.
authors.forename: Rochelle
authors.initials: R
authors.lastname: Garner
authors.affiliation: Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada.|Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|University of Ottawa, Ottawa, Ontario, Canada.|Bruyère Research Institute, Ottawa, Ontario, Canada.|School of Public and Population Health, University of Ottawa, Ottawa, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Manuel
authors.affiliation: Public Health Agency of Canada, Ottawa, Ontario, Canada.
authors.forename: Ron
authors.initials: R
authors.lastname: Wall
authors.affiliation: Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Finès
authors.affiliation: Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Bernier
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Department of Family and Community Medicine, Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Toronto Western Hospital Family Health Team, University Health Network, Toronto, Ontario, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Tu
authors.affiliation: Population Health Surveillance and Clinical Prevention, British Columbia Ministry of Health, Victoria, British Columbia, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Reimer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003198:Computer Simulation; D017281:Cost of Illness; D005260:Female; D005544:Forecasting; D017048:Health Care Costs / Q000639:trends*; D006304:Health Status; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D008962:Models, Theoretical; D009103:Multiple Sclerosis / Q000191:economics* / Q000453:epidemiology*; D015995:Prevalence; D055815:Young Adult
keywords: Canada; economic burden; incidence; microsimulation modelling; multiple sclerosis; prevalence