Economic burden of multiple sclerosis on Kuwait health care system

Maryam S Alowayesh 1, Samar F Ahmed 2 3, Jasem Al-Hashel 2 4, Raed Alroughani 5

Affiliations

14 May 2019

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doi: 10.1371/journal.pone.0216646

Abstract

Background: Multiple Sclerosis (MS) is a chronic neurological disease with heavy economic and social burdens resulting in significant disability.

Objective: This study aims to (1) measure the cost of health resources utilization by MS patients and (2) to examine the difference in utilization and its attributed costs amongst patients who may have a different course of MS and expanded disability status scale (EDSS) scores.

Methods: A cross-sectional study using Kuwait National MS registry was conducted to estimate the costs of utilization of resources from 2011 to 2015.

Results: Between the period 2011-2015, 1344 MS patients were included in the registry. The average annual cost per MS patient has increased from $10,271 in 2011 to $17,296 in 2015. Utilization of disease-modifying therapies (DMTs) was the main driver of costs reaching 89.9% in 2015. Throughout the five-year period, the occurrence of relapses decreased from 21.8% to 12.2% (p <0.0001). During this same period, ambulatory relapse treatment increased by 5.8% while hospitalizations decreased by 2.6%. Patients with a moderate EDSS score (3.5-6) had the highest average cost (p<0.0001) compared to mild and severe EDSS scores.

Conclusions: Multiple sclerosis has been a significant economic burden on the Kuwait healthcare system. DMTs are the main driver of cost.

Conflict of interest statement

Dr Alroughani received honoraria as a speaker and for serving in scientific advisory board from Bayer, Biogen, Novartis, Sanofi-Genzyme, Roche and Merck. Drs Alowayesh, Ahmed, and Al-Hashel have nothing to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Total cost per year and mean cost per patient per year.

Fig 1. Total cost per year and mean cost per patient per year.

Fig 2. Utilization of treatments (DMTs) 2011–2015, by type of intake* (%). * IM (intramuscular): Avonex; IV (intravenous): Tysabri, Lemtrada, Rituxan; PO (per os): Aubagio, Tecfidera, Gilenya, SC (subcutaneous): Betaferon, Rebif.

Fig 2. Utilization of treatments (DMTs) 2011–2015, by type of intake* (%). * IM (intramuscular): Avonex; IV (intravenous): Tysabri, Lemtrada, Rituxan; PO (per os): Aubagio, Tecfidera, Gilenya, SC (subcutaneous): Betaferon, Rebif.

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References

  1.  
    1. Patwardhan MB, Matchar DB, Samsa GP, McCrory DC, Williams RG, Li TT Cost of multiple sclerosis by level of disability: a review of literature. Mult Scler 2005;11:232–239. 10.1191/1352458505ms1137oa - DOI - PubMed
  2.  
    1. Simmons RD. Life issues in multiple sclerosis. Nat Rev Neurol 2010;6:603–610. 10.1038/nrneurol.2010.143 - DOI - PubMed
  3.  
    1. Naci H, Fleurence R, Birt J, Duhig A. Economic Burden of Multiple Sclerosis: A Systematic Review of the Literature. Pharmacoeconomics 2010;28(5):363–379. 10.2165/11532230-000000000-00000 - DOI - PubMed
  4.  
    1. Kobelt G, Pugliatti M. Cost of multiple sclerosis in Europe. Eur J Neurol 2005;12(Supp. 1):S63–S67.
  5.  
    1. Pohar SL, Jones CA, Warren S, Turpin KV, Warren K. Health status and health care utilization of multiple sclerosis in Canada. Can J Neurol Sci 2007;34(2):167–174. - PubMed
  6.  
    1. Pope GC, Urato CJ, Kulas ED, Kronick R, Gilmer T. Prevalence, expenditures, utilization, and payment for persons with MS in insured populations (provisional record). Neurology 2002;58:37–43. - PubMed
  7.  
    1. Gottberg K, Einarsson U, Fredrikson S, von Koch L, Holmqvist LW. Multiple sclerosis in Stockholm County: a pilot study of utilization of health-care resources, patient satisfaction with care and impact on family caregivers. Acta Neurol Scand 2002;106(5):241–247. - PubMed
  8.  
    1. Beckerman H, van Zee IE, de Groot V, van den Bos GA, Lankhorst GJ, Dekker J. Utilization of health care by patients with multiple sclerosis is based on professional and patient-defined health needs. Mult Scler 2008;00:1–11. - PubMed
  9.  
    1. Stolp-Smith KA, Atkinson EJ, Campion ME, O'Brien PC, Rodriguez M. Health care utilization in multiple sclerosis: a population-based study in Olmsted County, MN. Neurology 1998;50(6):1594–1600. - PubMed
  10.  
    1. Adelman G1, Rane SG, Villa KF. The cost burden of multiple sclerosis in the United States: a systematic review of the literature. J Med Econ 2013;16(5):639–647. 10.3111/13696998.2013.778268 - DOI - PubMed
  11.  
    1. Kanavos P, Tinelli M, Efthymiadou O, Visintin E, Grimaccia F, Mossman J. Towards better outcomes in multiple sclerosis by addressing policy change:The International MultiPlE Sclerosis Study (IMPrESS). London School of Economics; UK: 2016
  12.  
    1. Alroughani R, Ahmed SF, Behbahani R, Khan R, Thussu A, Alexander KJ. Increasing prevalence and incidence rates of multiple sclerosis in Kuwait. Mult Scler 2014;20(5):543–547. 10.1177/1352458513504328 - DOI - PubMed
  13.  
    1. Changik Jo. Cost-of-illness studies: concepts, scopes, and methods. Clinical and Molecular Hepatology 2014;20:327–337. 10.3350/cmh.2014.20.4.327 - DOI - PMC - PubMed
  14.  
    1. Alroughani R1, Ashkanani A, Lamdhade S. Clinical characteristics of multiple sclerosis in Kuwait: data from the new MS registry of Amiri Hospital. Int J Neurosci 2012. February;122(2):82–7. 10.3109/00207454.2011.630543 - DOI - PubMed
  15.  
    1. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011;69:292–302. 10.1002/ana.22366 - DOI - PMC - PubMed
  16.  
    1. Lublin FD and Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology 1996;46:907–911. - PubMed
  17.  
    1. Trisolini M, Honeycutt A, Wiener J, Lesesne S. Global Economic Impact of Multiple Sclerosis: A Literature Review. Multiple Sclerosis International Federation (UK) and RTI International (USA) 2010.
  18.  
    1. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an Expanded Disability Status Scale (EDSS). Neurology 1983;33(11):1444–1452. - PubMed
  19.  
    1. Kalincik T, Cutter G, Spelman T, Jokubaitis V, Havrdova E, Horakova D,et al. Brain 2015;138(Pt 11):3287–98. 10.1093/brain/awv258 - DOI - PubMed
  20.  
    1. Kister I, Chamot E, Salter AR, Cutter GR, Bacon TE, Herbert J. Disability in multiple sclerosis: a reference for patients and clinicians. Neurology 2013;80:1018–1024. 10.1212/WNL.0b013e3182872855 - DOI - PMC - PubMed
  21.  
    1. Dunn OJ. Multiple comparisons using rank sums. Technometrics 1963; 6:241–252.
  22.  
    1. Hurvich CM, Tsai CL. Bias of the corrected AIC criterion for under fitted regression and time series models. Biomelrika 1991;78:3:499–509.
  23.  
    1. Torabipour A, Asl ZA, Majdinasab N, Ghasemzadeh R, Tabesh H, Arab M. A Study on the Direct and Indirect Costs of Multiple Sclerosis Based on Expanded Disability Status Scale Score in Khuzestan, Iran. International Journal of Preventive Medicine 2014;5(9):1131–1138. - PMC - PubMed
  24.  
    1. Kobelt G, Thompson A, Berg J, Gannedahl M, Eriksson J3; MSCOI Study Group; European Multiple Sclerosis Platform. New insights into the burden and costs of multiple sclerosis in Europe. Mult Scler 2017;23(8):1123–1136. 10.1177/1352458517694432 - DOI - PMC - PubMed
  25.  
    1. Jones E, Pike J, Marshall T, Ye X. 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. BMC Health Services Research 2016;16:294–304 10.1186/s12913-016-1532-1 - DOI - PMC - PubMed
  26.  
    1. Ernstsson O, Gyllensten H, Alexanderson K, Tinghög P, Friberg E, Norlund A. Cost of Illness of Multiple Sclerosis—A Systematic Review. PLoS ONE 2016;11(7):e0159129 10.1371/journal.pone.0159129 - DOI - PMC - PubMed
  27.  
    1. Kalincik T, Brown JWL, Robertson N, Willis M, Scolding N, Rice CM, et al. Treatment effectiveness of alemtuzumab compared with natalizumab, fingolimod, and interferon beta in relapsing-remitting multiple sclerosis: a cohort study. Lancet Neurol 2017;16(4):271–281. 10.1016/S1474-4422(17)30007-8 - DOI - PubMed
  28.  
    1. Spelman T, Kalincik T, Jokubaitis V, Zhang A, Pellegrini F, Wiendl H, et al. Comparative efficacy of first-line natalizumab vs IFN-β or glatiramer acetate in relapsing MS. Neurol Clin Pract 2016;6(2):102–115. 10.1212/CPJ.0000000000000227 - DOI - PMC - PubMed
  29.  
    1. Braune S, Lang M, Bergmann A; NeuroTransData Study Group. Efficacy of fingolimod is superior to injectable disease-modifying therapies in second-line therapy of relapsing-remitting multiple sclerosis. J Neurol 2016;263(2):327–333. 10.1007/s00415-015-7970-6 - DOI - PMC - PubMed
  30.  
    1. He A, Spelman T, Jokubaitis V, Havrdova E, Horakova D, Trojano M, et al. Comparison of switch to fingolimod or interferon beta/glatiramer acetate in active multiple sclerosis. JAMA Neurol 2015; 72(4):405–413. 10.1001/jamaneurol.2014.4147 - DOI - PubMed
  31.  
    1. Fox RJ, Chan A, Zhang A, Xiao J, Levison D, Lewin JB, et al. Comparative effectiveness using a matching-adjusted indirect comparison between delayed-release dimethyl fumarate and fingolimod for the treatment of multiple sclerosis. Curr Med Res Opin 2017;33(2):175–183. 10.1080/03007995.2016.1248380 - DOI - PubMed
  32.  
    1. Wicks P, Rasouliyan L, Katic B, Nafees B, Flood E, Sasané R. The real-world patient experience of fingolimod and dimethyl fumarate for multiple sclerosis. BMC Res Notes 2016;9(1):434 10.1186/s13104-016-2243-8 - DOI - PMC - PubMed
  33.  
    1. Parisé H, Laliberté F, Lefebvre P, Duh MS, Kim E, Agashivala N, et al. Direct and indirect cost burden associated with multiple sclerosis relapses: Excess costs of persons with MS and their spouse caregivers. J Neurol Sci 2013;330:71–77. 10.1016/j.jns.2013.04.007 - DOI - PubMed
  34.  
    1. O'Connelln K, Kelly SB, Fogarty E, Duggan M, Buckley L, Hutchinson M, et al. Economic costs associated with an MS relapse. Multiple Sclerosis and Related Disorders 2014;3:678–683. 10.1016/j.msard.2014.09.002 - DOI - PubMed
  35.  
    1. Bayas A, Mäurer M.Teriflunomide for the treatment of relapsing-remitting multiple sclerosis: patient preference and adherence. Patient Prefer Adherence 2015;9:265–274. 10.2147/PPA.S61651 - DOI - PMC - PubMed
  36.  
    1. Bergvall N, Petrilla AA, Karkare SU, Lahoz R, Agashivala N, Pradhan A, et al. Persistence with and adherence to fingolimod compared with other disease-modifying therapies for the treatment of multiple sclerosis: a retrospective US claims database analysis. J Med Econ 2014;17(10):696–707. 10.3111/13696998.2014.940422 - DOI - PubMed
  37.  
    1. Agashivala N, Wu N, Abouzaid S, Wu Y, Kim E, Boulanger L, et al. Compliance to fingolimod and other disease-modifying treatments in multiple sclerosis patients, a retrospective cohort study. BMC Neurol 2013;13:138 10.1186/1471-2377-13-138 - DOI - PMC - PubMed
  38.  
    1. Brandes D, Raimundo K, Agashivala N, Kim E. Implications of Real-world Adherence on Cost-effectiveness Analysis in Multiple Sclerosis. J Med Econ 2013;16(4):547–551. 10.3111/13696998.2013.774281 - DOI - PubMed
  39.  
    1. Burks J, Marshall TS, Ye X. Adherence to disease-modifying therapies and its impact on relapse, health resource utilization, and costs among patients with multiple sclerosis. ClinicoEconomics and Outcomes Research 2017;9:251–252. 10.2147/CEOR.S130334 - DOI - PMC - PubMed

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