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Cárdenas-Robledo S, Arenas-Vargas LE, Arenas RD, Gaspar-Toro JM, Muñoz-Rosero ÁM, Tafur-Borrero AH, Marín-Medina DS, Acosta-Fajardo HA, Guío-Sánchez C, López-Reyes L. Treatment patterns and persistence on disease modifying therapies for multiple sclerosis and its associated factors. BMC Neurol 2024; 24:108. [PMID: 38566012 PMCID: PMC10986095 DOI: 10.1186/s12883-024-03594-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Effective interventions for Multiple Sclerosis require timely treatment optimization which usually involves switching disease modifying therapies. The patterns of prescription and the reasons for changing treatment in people with MS, especially in low prevalence populations, are unknown. OBJECTIVES To describe the persistence, reasons of DMT switches and prescription patterns in a cohort of Colombian people with MS. METHODS We conducted a retrospective observational study including patients with confirmed MS with at least one visit at our centre. We estimated the overall incidence rate of medication changes and assessed the persistence on medication with Kaplan-Meier survival estimates for individual medications and according to efficacy and mode of administration. The factors associated with changing medications were assessed using adjusted Cox proportional-hazards models. The reasons for switching medication changes were described, and the prescription patterns were assessed using network analysis, with measures of centrality. RESULTS Seven hundred one patients with MS were included. Mean age was 44.3 years, and 67.9% were female. Mean disease duration was 11.3 years and 84.5% had relapsing MS at onset, with median EDSS of 1.0. Treatment was started in 659 (94%) of the patients after a mean of 3 years after MS symptom onset. Among them, 39.5% maintained their initial DMT, 29.9% experienced a single DMT change, while 18.7% went through two, and 11.9% had three or more DMT changes until the final follow-up. The total number of treatment modifications reached 720, resulting in an incidence rate of 1.09 (95% confidence interval: 1.01-1.17) per patient per year The median time to change after the first DMT was 3.75 years, and was not different according to the mode of administration or efficacy classification. The main reasons for changing DMT were MS activity (relapses, 56.7%; MRI activity, 18.6%), followed by non-serious adverse events (15.3%) and disability (11.1%). Younger age at MS onset, care under our centre and insurer status were the main determinants of treatment change. Network analysis showed that interferons and fingolimod were the most influential DMTs. CONCLUSIONS A majority of patients switch medications, mostly due to disease activity, and in association with age and insurer status.
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Affiliation(s)
- Simón Cárdenas-Robledo
- Centro de Esclerosis Múltiple (CEMHUN), Departamento de Neurología, Hospital Universitario Nacional de Colombia, Calle 44 # 59-75, Bogotá, Colombia.
- Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - Laura Estefanía Arenas-Vargas
- Centro de Esclerosis Múltiple (CEMHUN), Departamento de Neurología, Hospital Universitario Nacional de Colombia, Calle 44 # 59-75, Bogotá, Colombia
| | - Rubén Darío Arenas
- Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Jorge Mario Gaspar-Toro
- Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Ángela María Muñoz-Rosero
- Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | | | - Daniel Stiven Marín-Medina
- Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | | | - Claudia Guío-Sánchez
- Centro de Esclerosis Múltiple (CEMHUN), Departamento de Neurología, Hospital Universitario Nacional de Colombia, Calle 44 # 59-75, Bogotá, Colombia
| | - Lorena López-Reyes
- Centro de Esclerosis Múltiple (CEMHUN), Departamento de Neurología, Hospital Universitario Nacional de Colombia, Calle 44 # 59-75, Bogotá, Colombia
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Misnaza-Castrillón SP, Martínez-Angarita JC, Martínez-Gómez VM. [Geographic distribution of mortality due to multiple sclerosis in Colombia, 2010-2015]. Rev Salud Publica (Bogota) 2023; 21:444-451. [PMID: 36753268 DOI: 10.15446/rsap.v21n4.76176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 05/30/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To characterize the geographical distribution of extended mortality due to multiple sclerosis in Colombia between 2010 and 2015. MATERIALS AND METHODS Descriptive study to analyze the geographical distribution of mortality rates from the death certificates between 2010 and 2015. State and municipal mortality rates were calculated and adjusted by age and sex. RESULTS 56.8% of deaths occurred in women and 28.7% in people aged 50 to 59 years. In 2010, the national mortality rate was 0.28 per 100,000 people, and the highest was recorded in Casanare (0.59 per 100,000). In 2011, the rate was 0.24, and Buenaventura recorded the highest (0.51). In 2012, the rate was 0.27, and la Guajira recorded the highest (0.34). In 2013, the rate was 0.27, and the highest was in Arauca (0.83). In 2014, the rate was 0.32, and the highest was occurred in Putumayo (1.14). In 2015 the rate was 0.23 and Santa Marta recorded the highest (0.58). By municipalities, Sativanorte, Arcabuco (Boyacá), San Miguel, la Paz (Santander) and la Merced (Caldas) recorded the highest rates. CONCLUSION The pattern of mortality due to multiple sclerosis is similar in the study period. The highest burden of mortality was recorded in women and in municipalities of Santander and Boyacá.
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Affiliation(s)
- Sandra P Misnaza-Castrillón
- SM: OD. Esp. Gerencia de la Salud Pública. M. Sc. Administración en Salud. Instituto Nacional de Salud. Bogotá, Colombia.
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Dahham J, Rizk R, Hiligsmann M, Daccache C, Khoury SJ, Darwish H, Evers S, Kremer I. The Economic and societal burden of multiple sclerosis on lebanese society: a cost-of-illness and quality of life study protocol. Expert Rev Pharmacoecon Outcomes Res 2021; 22:869-876. [PMID: 34826264 DOI: 10.1080/14737167.2022.2008242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This protocol describes the estimation of the societal costs and quality-of-life (QOL) burden of multiple sclerosis (MS) in Lebanon. This cross-sectional, prevalence-based burden-of-illness study was carried out in a premier MS center in Lebanon. We enrolled Lebanese patients aged 18 years and older who had been diagnosed with MS more than 6 months. The study uses a bottom-up approach to estimate the cost-of-illness (COI) and QOL using a retrospective face-to-face interview questionnaire. This resource utilization questionnaire was adapted to the Lebanese context by clinical and health economics experts. The methodologies used to estimate the consumption of healthcare resources, informal care, and productivity losses are well-defined and aligned with the Lebanese healthcare system. Costs are presented overall and by MS severity levels. QOL is measured using the EuroQOL (EQ-5D-5 L) and Multiple Sclerosis International Quality of Life (MusiQoL) instrument. This protocol pioneers in informing the design of future COI and QOL studies in low - and middle-income countries (LMICs), as the methods used could be applied in similar LMICs. Furthermore, we provide recommendations and discuss the challenges of conducting a high-quality burden-of-illness study in LMICs and the steps taken to meet them, using the case of Lebanon.
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Affiliation(s)
- Jalal Dahham
- Department of Health Services Research, Care and Public Health Research Institute (Caphri), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Rana Rizk
- Institut National de Santé Publique, D'épidémiologie Clinique Et de Toxicologie (Inspect-lb), Beirut, Lebanon
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (Caphri), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Caroline Daccache
- Department of Health Services Research, Care and Public Health Research Institute (Caphri), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, Department of Neurology, Faculty of medicine American University of Beirut Medical Center, Beirut, Lebanon
| | - Hala Darwish
- Hariri School of Nursing, American University of Beirut, Lebanon Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Lebanon
| | - Silvia Evers
- Department of Health Services Research, Care and Public Health Research Institute (Caphri), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Centre for Economic Evaluations and Machine Learning, Trimbos Institute, Utrecht, The Netherlands
| | - Ingrid Kremer
- Department of Health Services Research, Care and Public Health Research Institute (Caphri), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Dahham J, Rizk R, Kremer I, Evers SMAA, Hiligsmann M. Economic Burden of Multiple Sclerosis in Low- and Middle-Income Countries: A Systematic Review. PHARMACOECONOMICS 2021; 39:789-807. [PMID: 33956330 PMCID: PMC8200340 DOI: 10.1007/s40273-021-01032-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND Although the economic burden of multiple sclerosis (MS) in high-income countries (HICs) has been extensively studied, information on the costs of MS in low- and middle-income countries (LMICs) remains scarce. Moreover, no review synthesizing and assessing the costs of MS in LMICs has yet been undertaken. OBJECTIVE Our objective was to systematically identify and review the cost of illness (COI) of MS in LMICs to critically appraise the methodologies used, compare cost estimates across countries and by level of disease severity, and examine cost drivers. METHODS We conducted a systematic literature search for original studies in English, French, and Dutch containing prevalence or incidence-based cost data of MS in LMICs. The search was conducted in MEDLINE (Ovid), PubMed, Embase (Ovid), Cochrane Library, National Health Service Economic Evaluation Database (NHS EED), Econlit, and CINAHL (EBSCO) on July 2020 without restrictions on publication date. Recommended and validated methods were used for data extraction and analysis to make the results of the COI studies comparable. Costs were adjusted to $US, year 2019 values, using the World Bank purchasing power parity and inflated using the consumer price index. RESULTS A total of 14 studies were identified, all of which were conducted in upper-middle-income economies. Eight studies used a bottom-up approach for costing, and six used a top-down approach. Four studies used a societal perspective. The total annual cost per patient ranged between $US463 and 58,616. Costs varied across studies and countries, mainly because of differences regarding the inclusion of costs of disease-modifying therapies (DMTs), the range of cost items included, the methodological choices such as approaches used to estimate healthcare resource consumption, and the inclusion of informal care and productivity losses. Characteristics and methodologies of the included studies varied considerably, especially regarding the perspective adopted, cost data specification, and reporting of costs per severity levels. The total costs increased with greater disease severity. The cost ratios between different levels of MS severity within studies were relatively stable; costs were around 1-1.5 times higher for moderate versus mild MS and about two times higher for severe versus mild MS. MS drug costs were the main cost driver for less severe MS, whereas the proportion of direct non-medical costs and indirect costs increased with greater disease severity. CONCLUSION MS places a huge economic burden on healthcare systems and societies in LMICs. Methodological differences and substantial variations in terms of absolute costs were found between studies, which made comparison of studies challenging. However, the cost ratios across different levels of MS severity were similar, making comparisons between studies by disease severity feasible. Cost drivers were mainly DMTs and relapse treatments, and this was consistent across studies. Yet, the distribution of cost components varied with disease severity.
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Affiliation(s)
- Jalal Dahham
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Rana Rizk
- Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie (INSPECT-Lb), Beirut, Lebanon
| | - Ingrid Kremer
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Silvia M. A. A. Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
- Centre for Economic Evaluations and Machine Learning, Trimbos Institute, Utrecht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
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Lasalvia P, Hernández F, Castañeda-Cardona C, Cuestas JA, Rosselli D. Cost-Effectiveness of Natalizumab Compared With Fingolimod for Relapsing-Remitting Multiple Sclerosis Treatment in Colombia. Value Health Reg Issues 2020; 23:13-18. [PMID: 31999987 DOI: 10.1016/j.vhri.2019.08.481] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 07/20/2019] [Accepted: 08/28/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Multiple sclerosis (MS) is a degenerative neurological disorder. Treatment aims to avoid relapses and disability progression. The purpose of this study was to evaluate the cost-effectiveness of natalizumab compared with fingolimod for treating highly active relapsing-remitting MS (RRMS) patients from the Colombian third-party payer perspective. METHODS We used a Markov economic model from the perspective of the Colombian healthcare system to estimate the cost-effectiveness of natalizumab compared with fingolimod for RRMS with high disease activity or failure of interferons as first-line therapy. This model was centered on disability progression and relapses. We considered a 5-year time horizon with a 5% discount rate. We included only direct medical costs. Local experts were consulted to obtain resource utilization estimates, and local standardized costing methodologies and sources were used. Outcome was considered in terms of quality-adjusted life-years (QALYs). Utilities were extracted or calculated from the literature. Transition probabilities were calculated from available efficacy and safety information (1 USD = 3050.98 COP). RESULTS Natalizumab showed lower total costs (USD 80 024 vs USD 98 137) and higher QALY yield (3.01 vs 2.94) than fingolimod, dominating it (incremental cost-effectiveness ratio = -$1861). Univariate sensitivity analysis showcased the relevance of the measures of effect on disability progression for natalizumab on model results. Probabilistic sensitivity analysis replicated base-case results in most simulations. CONCLUSIONS This study showed that natalizumab dominated fingolimod with lower costs and higher QALYs in patients with high-activity RRMS. These results are consistent with previous published international literature.
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Affiliation(s)
- Pieralessandro Lasalvia
- Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Medical School, Bogota, Colombia
| | | | | | | | - Diego Rosselli
- Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Medical School, Bogota, Colombia.
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Gracia F, Larreategui M, Rodríguez G, Benzadón A, Ortiz M, Morales D, Domínguez C, Carrillo RE, Valderrama C, Lizán L, Armién B. Costs of multiple sclerosis in Panama from societal, patient perspectives and health-related quality of life. PLoS One 2018; 13:e0204681. [PMID: 30304006 PMCID: PMC6179239 DOI: 10.1371/journal.pone.0204681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/12/2018] [Indexed: 01/06/2023] Open
Abstract
The purpose of this work is to estimate the costs associated with managing patients with MS in Panama and evaluating the impact of the disease on their health-related quality of life (HRQoL). Multicentric observational, retrospective, cross-sectional study. The costs were estimated from societal and patient perspectives and expressed in USD, 2015. The focus of the study is based on prevalence and on a “bottom-up” approach. To estimate the total cost per patient, annual reported use for each resource was multiplied by its unit cost. To evaluate HRQoL, patients completed the EQ-5D-3L questionnaire. 108 patients took part in the study. 82.41% were women with 44.78 (SD: 12.27) years. 61.11% presented mild (EDSS = 0–3.5), 25.93% moderate (EDSS = 3.5–6) and 12.96%, severe disability (EDSS≥6.5). The mean annual cost from the patient’s perspective was estimated at 777.99 USD (SD: 1,741.45) per patient. The mean cost from a societal perspective was estimated at 23,803.21 USD (SD: 13,331.83) per patient. Disease-modifying therapies (DMT) accounted for the main component of the cost. A deterioration in HRQoL was observed as the disease advances and as disability increases, with mobility and usual activities being the areas most affected by its progression. From both perspective, the cost per MS patient in Panama is high. In addition to the high economic impact, MS also exerts a negative impact on patient HRQoL, which increases as the disease advances.
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Affiliation(s)
- Fernando Gracia
- Universidad Interamericana de Panamá, Panamá City, Panamá
- Hospital Santo Tomás, Panamá City, Panamá
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá City, Panamá
- * E-mail: (FG); (BA)
| | | | | | - Aaron Benzadón
- Complejo Hospitalario Metropolitano Arnulfo Arias Madrid-Caja de Seguro Social, Panamá City, Panamá
| | | | | | - Claudia Domínguez
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá City, Panamá
| | | | - Carlos Valderrama
- Hospital Regional Rafael Hernández-Caja de Seguro Social, Chiriquí, Panamá
| | - Luís Lizán
- Outcomes’10, Universitat Jaume I, Castellón, Spain
| | - Blas Armién
- Hospital Santo Tomás, Panamá City, Panamá
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá City, Panamá
- * E-mail: (FG); (BA)
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Muñoz-Galindo IM, Moreno Calderón JA, Guarín Téllez NE, Arévalo Roa HO, Díaz Rojas JA. Health Care Cost for Multiple Sclerosis: The Case of a Health Insurer in Colombia. Value Health Reg Issues 2018; 17:14-20. [PMID: 29605798 DOI: 10.1016/j.vhri.2017.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 10/30/2017] [Accepted: 12/01/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND There have been many studies on the cost of multiple sclerosis in countries with high prevalence, whereas in Latin America such analyses are few. Taking into consideration the burden of this disease and the high financial impact of treatment on the health care system, it is necessary to know the behavior of cost of illness. OBJECTIVES To describe the direct costs associated with health care in patients with multiple sclerosis affiliated with a health insurer in Colombia. METHODS An analysis of direct costs of disease was performed from the perspective of the third-party payer. A direct measurement from the technical costing "top-down" approach was used. Data were adjusted for inflation and expressed in 2014 US dollars. RESULTS The average annual cost per patient for the country was $29,339 (2010), $20,956 (2011), $23,892 (2012), $24,148 (2013), and $22,688 (2014). Drug therapy represented 86.1% of the total cost. Between 2010 and 2013, interferons accounted for the largest proportion of the costs of drug treatment (98.5% to 53%), whereas fingolimod showed an increase and accounted for 47% in 2014. CONCLUSIONS Medications account for the largest proportion of disease costs, with few variations in the last 5 years; nevertheless, the increase in the use of new pharmaceuticals poses a challenge to maintain the financial balance of health insurance.
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Skromne-Eisenberg E. Disease-modifying therapies in multiple sclerosis in Latin America. Mult Scler J Exp Transl Clin 2017; 3:2055217317723369. [PMID: 28979794 PMCID: PMC5617092 DOI: 10.1177/2055217317723369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/29/2017] [Indexed: 11/24/2022] Open
Abstract
The treatment of multiple sclerosis (MS) has become increasingly complex during the last 10 years, mainly because of the advent of new and more potent disease-modifying therapies (DMTs). In Latin America, the therapeutic repertoire available for MS treatment is similar to the one in the rest of the world, but the high costs of these drugs, in conjunction with the limited resources of the social security health systems, makes the treatment of MS more difficult. For neurologists in Latin America, providing personalized MS treatment has become a challenge. We present a review of the status of the DMT in Central and South America, benefits as well as limitations for providing full access to these medications in Latin America.
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Stawowczyk E, Malinowski KP, Kawalec P, Moćko P. The indirect costs of multiple sclerosis: systematic review and meta-analysis. Expert Rev Pharmacoecon Outcomes Res 2015; 15:759-86. [DOI: 10.1586/14737167.2015.1067141] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Ysrraelit C, Caceres F, Villa A, Marcilla MP, Blanche J, Burgos M, Parera IC, Colombo O, Crespo E, Deri N, Labal P, Maluendez M, Martinez A, Melcon M, Nofal P, Reich E, Sinay V, Tarulla A, Vetere S, Barboza A, Rey R, Moreno M, Bacile A, Rojas JI, Kuperman G, Resk M, Seifer G, Machinicki G, Cuneo J. ENCOMS: Argentinian survey in cost of illness and unmet needs in multiple sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:337-43. [PMID: 24863508 DOI: 10.1590/0004-282x20140016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 02/10/2014] [Indexed: 11/22/2022]
Abstract
UNLABELLED The objective of the study was to assess the cost of multiple sclerosis (MS) patients in Argentina categorized by disease severity using a societal perspective. METHOD Cross-sectional study including MS patients from 21 MS centers in 12 cities of Argentina. Patients were stratified by disease severity using the expanded disability status scale (EDSS) (group 1 with EDSS score between 0 and 3; group 2 with EDSS >3 and <7; group 3 with EDSS ≥7). Direct and indirect costs were analyzed for the second quarter of 2012 from public sources and converted to US Dollars. RESULTS 266 patients were included. Mean annual cost per MS patient was USD 36,025 (95%CI 31,985-38,068) for patients with an EDSS between 0-3; USD 40,705 (95%CI 37,199-46,300) for patients with EDSS >3 and <7, and USD 50,712 (95%CI 47,825-62,104) for patients with EDSS ≥7. CONCLUSIONS This is the first Argentine study evaluating the costs of MS considering disease severity.
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Affiliation(s)
| | - Fernando Caceres
- Instituto Neurociencias de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | - Norma Deri
- Hospital Fernandez, Buenos Aires, Argentina
| | | | | | | | | | - Pedro Nofal
- Centro Regional Integral de Neurociencia, Argentina
| | | | | | | | | | | | - Roberto Rey
- Instituto Argentino de Investigación Neurologica, Buenos Aires, Argentina
| | | | | | - Juan I Rojas
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Macías-Islas MA, Soria-Cedillo IF, Velazquez-Quintana M, Rivera VM, Baca-Muro VI, Lemus-Carmona EA, Chiquete E. Cost of care according to disease-modifying therapy in Mexicans with relapsing-remitting multiple sclerosis. Acta Neurol Belg 2013; 113:415-20. [PMID: 23670405 DOI: 10.1007/s13760-013-0200-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 04/16/2013] [Indexed: 11/26/2022]
Abstract
Limited data exist on the costs of care of patients with multiple sclerosis (MS) in low- to middle-income nations. The purpose of this study was to describe the economic burden associated with care of Mexican patients with relapsing-remitting MS in a representative sample of the largest institution of the Mexican public healthcare system. We analysed individual data of 492 patients (67% women) with relapsing-remitting MS registered from January 2009 to February 2011 at the Mexican Social Security Institute. Direct costs were measured about the use of diagnostic tests, disease-modifying therapies (DMTs), symptoms control, medical consultations, relapses, intensive care and rehabilitation. Four groups were defined according to DMT alternatives: (1) interferon beta (IFNβ)-1a, 6 million units (MU); (2) IFNβ-1a, 12MU; (3) IFNβ-1b, 8MU; and (4) glatiramer acetate. All patients received DMTs for at least 1 year. The most frequently used DMT was glatiramer acetate (45.5%), followed by IFNβ-1a 12MU (22.6%), IFNβ-1b 8MU (20.7%), and IFNβ-1a 6MU (11.2%). The mean cost of a specialised medical consultation was €74.90 (US $107.00). A single relapse had a mean total cost of €2,505.97 (US $3,579.96). No differences were found in annualised relapse rates and costs of relapses according to DMT. However, a significant difference was observed in total annual costs according to treatment groups (glatiramer acetate being the most expensive), mainly due to differences in unitary costs of alternatives. From the public institutional perspective, when equipotent DMTs are used in patients with comparable characteristics, the costs of DMTs largely determine the total expenses associated with care of patients with relapsing-remitting MS in a middle-income country.
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Affiliation(s)
- Miguel A Macías-Islas
- Jefe del Departamento de Neurología, UMAE, Centro Médico Nacional de Occidente, IMSS, Belisario Domínguez #1000, Col. Independencia Oriente, C.P. 44340, Guadalajara, Jal, Mexico,
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Romano M, Machnicki G, Rojas JI, Frider N, Correale J. There is much to be learnt about the costs of multiple sclerosis in Latin America. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:549-55. [DOI: 10.1590/0004-282x20130082] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 04/03/2013] [Indexed: 11/22/2022]
Abstract
METHOD: A systematic review of the literature from 1990 to 2011 was conducted. Outcome measures included: mean cost of disease modifying therapies (DMTs), mean cost of treatment of relapses and mean cost of disease by stage stratification measured by the expanded disability status scale (EDSS). RESULTS: Seven studies from three countries (Brazil, Argentina and Colombia) were included. In 2004, in Argentina, the mean cost of DMT treatment was reported to be USD 35,000 per patient treated. In Brazil, the total MS expenditure of DMTs rose from USD 14,011,700 in 2006 to USD 122,575,000 in 2009. Patient costs ranged between USD 10,543 (EDSS 8-9.5) and USD 25,713 (EDSS 3-5.5). Indirect costs markedly increased for the EDSS 8-9.5 patients. CONCLUSION: Further research assessing the economic burden of MS in LA is warranted.
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Affiliation(s)
- Marina Romano
- Centro de Educacion Medica e Investigaciones Clinicas, Argentina
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Thompson JP, Abdolahi A, Noyes K. Modelling the cost effectiveness of disease-modifying treatments for multiple sclerosis: issues to consider. PHARMACOECONOMICS 2013; 31:455-69. [PMID: 23640103 PMCID: PMC3697004 DOI: 10.1007/s40273-013-0063-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Several cost-effectiveness models of disease-modifying treatments (DMTs) for multiple sclerosis (MS) have been developed for different populations and different countries. Vast differences in the approaches and discrepancies in the results give rise to heated discussions and limit the use of these models. Our main objective is to discuss the methodological challenges in modelling the cost effectiveness of treatments for MS. We conducted a review of published models to describe the approaches taken to date, to identify the key parameters that influence the cost effectiveness of DMTs, and to point out major areas of weakness and uncertainty. Thirty-six published models and analyses were identified. The greatest source of uncertainty is the absence of head-to-head randomized clinical trials. Modellers have used various techniques to compensate, including utilizing extension trials. The use of large observational cohorts in recent studies aids in identifying population-based, 'real-world' treatment effects. Major drivers of results include the time horizon modelled and DMT acquisition costs. Model endpoints must target either policy makers (using cost-utility analysis) or clinicians (conducting cost-effectiveness analyses). Lastly, the cost effectiveness of DMTs outside North America and Europe is currently unknown, with the lack of country-specific data as the major limiting factor. We suggest that limited data should not preclude analyses, as models may be built and updated in the future as data become available. Disclosure of modelling methods and assumptions could improve the transferability and applicability of models designed to reflect different healthcare systems.
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Affiliation(s)
- Joel P Thompson
- Department of Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642, USA.
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