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Monreal E, Ruiz PD, San Román IL, Rodríguez-Antigüedad A, Moya-Molina MÁ, Álvarez A, García-Arcelay E, Maurino J, Shepherd J, Cabrera ÁP, Villar LM. Value contribution of blood-based neurofilament light chain as a biomarker in multiple sclerosis using multi-criteria decision analysis. Front Public Health 2024; 12:1397845. [PMID: 38711771 PMCID: PMC11073490 DOI: 10.3389/fpubh.2024.1397845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/11/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction Multiple sclerosis (MS) is a chronic autoimmune demyelinating disease that represents a leading cause of non-traumatic disability among young and middle-aged adults. MS is characterized by neurodegeneration caused by axonal injury. Current clinical and radiological markers often lack the sensitivity and specificity required to detect inflammatory activity and neurodegeneration, highlighting the need for better approaches. After neuronal injury, neurofilament light chains (NfL) are released into the cerebrospinal fluid, and eventually into blood. Thus, blood-based NfL could be used as a potential biomarker for inflammatory activity, neurodegeneration, and treatment response in MS. The objective of this study was to determine the value contribution of blood-based NfL as a biomarker in MS in Spain using the Multi-Criteria Decision Analysis (MCDA) methodology. Materials and methods A literature review was performed, and the results were synthesized in the evidence matrix following the criteria included in the MCDA framework. The study was conducted by a multidisciplinary group of six experts. Participants were trained in MCDA and scored the evidence matrix. Results were analyzed and discussed in a group meeting through reflective MCDA discussion methodology. Results MS was considered a severe condition as it is associated with significant disability. There are unmet needs in MS as a disease, but also in terms of biomarkers since no blood biomarker is available in clinical practice to determine disease activity, prognostic assessment, and response to treatment. The results of the present study suggest that quantification of blood-based NfL may represent a safe option to determine inflammation, neurodegeneration, and response to treatments in clinical practice, as well as to complement data to improve the sensitivity of the diagnosis. Participants considered that blood-based NfL could result in a lower use of expensive tests such as magnetic resonance imaging scans and could provide cost-savings by avoiding ineffective treatments. Lower indirect costs could also be expected due to a lower impact of disability consequences. Overall, blood-based NfL measurement is supported by high-quality evidence. Conclusion Based on MCDA methodology and the experience of a multidisciplinary group of six stakeholders, blood-based NfL measurement might represent a high-value-option for the management of MS in Spain.
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Affiliation(s)
- Enric Monreal
- Department of Neurology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Red Española de Esclerosis Múltiple, Red de Enfermedades Inflamatorias, Universidad de Alcalá, Madrid, Spain
| | - Pilar Díaz Ruiz
- Department of Pharmacy, Hospital Nuestra Señora de Candelaria, Tenerife, Spain
| | | | | | | | | | | | | | | | | | - Luisa María Villar
- Department of Immunology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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Vudumula U, Patidar M, Gudala K, Karpf E, Adlard N. Evaluating the impact of early vs delayed ofatumumab initiation and estimating the long-term outcomes of ofatumumab vs teriflunomide in relapsing multiple sclerosis patients in Spain. J Med Econ 2023; 26:11-18. [PMID: 36472139 DOI: 10.1080/13696998.2022.2151270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the impact of early (at first-line) vs delayed (3-year delay) ofatumumab initiation and long-term clinical, societal, and economic outcomes of ofatumumab vs teriflunomide in relapsing multiple sclerosis (RMS) patients from a Spanish societal perspective. METHODS A cost-consequence analysis was conducted using an Expanded Disability Status Scale (EDSS)-based Markov model. Inputs were sourced from ASCLEPIOS I and II trials and published literature. RESULTS At the end of 10 years, compared with first-line teriflunomide treatment, early first-line ofatumumab initiation was projected to result in 35.6% fewer patients progressing to EDSS ≥ 7 and 27.8% fewer relapses. The ofatumumab cohort required 7.3% reduced informal care time and had 19% fewer disability-adjusted life years (DALYs) than the teriflunomide cohort. A 3-year delay in ofatumumab treatment (3-year teriflunomide + 7-year ofatumumab) was projected to result in 32.2% more patients progressing to EDSS ≥ 7, 20.2% more relapses, 5.4% increased informal care time, and 16.6% more DALYs compared with early ofatumumab initiation. Early ofatumumab initiation was associated with total annual cost savings (excluding disease-modifying-therapies' acquisition costs) of €35,328 ($34,549; conversion factor 1€= $1.02255) and €24,373 ($23,836) per patient vs teriflunomide and 3-year delayed ofatumumab initiation, respectively. CONCLUSIONS This study highlights the benefits of early initiation of high-efficacy therapy such as ofatumumab vs its delayed initiation for improving the outcomes in RMS patients (having characteristics similar to those of patients included in the ASCLEPIOS trials). Ofatumumab treatment was projected to provide improved long-term clinical, societal, and economic outcomes vs teriflunomide treatment in RMS patients from a Spanish societal perspective.
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Affiliation(s)
| | - Mausam Patidar
- Patient Access Services, Novartis Healthcare Pvt. Ltd, Hyderabad, India
| | - Kapil Gudala
- Patient Access Services, Novartis Healthcare Pvt. Ltd, Hyderabad, India
| | | | - Nicholas Adlard
- Health Economics and Outcomes Research, Novartis Pharma AG, Basel, Switzerland
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García López FJ, García-Merino A, Alcalde-Cabero E, de Pedro-Cuesta J. Incidence and prevalence of multiple sclerosis in Spain: a systematic review. Neurologia 2022:S2173-5808(22)00177-8. [PMID: 36410655 DOI: 10.1016/j.nrleng.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Greater understanding of the prevalence and incidence of multiple sclerosis in Spain and their temporal trends is necessary to improve the allocation of healthcare resources and to study aetiological factors. METHODS We performed a systematic search of the MedLine database and reviewed the reference lists of the articles gathered. We collected studies reporting prevalence or incidence rates of multiple sclerosis in any geographical location in Spain, with no time limits. In 70% of cases, data were extracted by 2 researchers (FGL and EAC); any discrepancies were resolved by consensus. RESULTS We identified 51 prevalence and 33 incidence studies published between 1968 and 2018. In the adjusted analysis, the number of prevalent cases per 100 000 population increased by 26.6 (95% confidence interval [CI], 21.5-31.8) every 10 years. After adjusting for year and latitude, the number of incident cases per 100 000 population increased by 1.34 (95% CI, 0.98-1.69) every 10 years. We observed a trend toward higher prevalence and incidence rates at higher latitudes. CONCLUSIONS The prevalence of multiple sclerosis in Spain has increased in recent decades, although case ascertainment appears to be incomplete in many studies. Incidence rates have also increased, but this may be due to recent improvements in the detection of new cases.
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Affiliation(s)
- F J García López
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
| | - A García-Merino
- Unidad de Neuroinmunología, Fundación para la Investigación Biomédica Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Majadahonda, Madrid, Spain
| | - E Alcalde-Cabero
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Agencia de Evaluación de Tecnologías Sanitarias, Instituto de Salud Carlos III, Madrid, Spain
| | - J de Pedro-Cuesta
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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García López F, García-Merino A, Alcalde-Cabero E, de Pedro-Cuesta J. Incidencia y prevalencia de la esclerosis múltiple en España. Una revisión sistemática. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Dal SR, Elphick TL, Fuller K. Epidemiological study of multiple sclerosis in Illawarra region. Intern Med J 2022. [PMID: 35112760 DOI: 10.1111/imj.15704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/03/2022] [Accepted: 01/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating disease which causes significant disabilities. Latest MS epidemiological data in Australia reveals rising prevalence. No epidemiological study of MS has been conducted so far in the Illawarra region. AIM To calculate prevalence and incidence of MS in the Illawarra and compare with other regions', states' and national prevalence data. METHOD Data of MS patients in the Illawarra were collected from hospital medical records, ambulatory care units and hospital pharmacy. Prevalence was calculated for alive MS patients on June 30, 2018 expressed per 100 000 population. Yearly adjusted incidence rate was calculated for 10 years (2009-2019), expressed as cases per 100 000 population-years. RESULTS Estimated MS prevalence in the Illawarra was 116.6 per 100 000 population with yearly incidence (2009-2019) of 5.06 cases per 100 000 population-years (female to male, 3:1). Relapsing-remitting MS (RRMS) was the most common type (277/397 ~ 69.7%) with primary progressive MS (PPMS) in 52/397 ~ 13%, and secondary progressive MS (SPMS) in 45/397 ~ 11.3% (unknown in 23). Commonest age at diagnosis ranged between 30-39 years for all types with RRMS and PPMS between 30-39 years and 40-49 years respectively. The most commonly recorded treatment was natalizumab (103 patients) followed by fingolimod (82 patients) and interferon (58 patients). CONCLUSION The calculated MS prevalence in the Illawarra is higher than NSW and Australian average MS prevalence. Further epidemiological studies focusing on MS risk factors and other factors bearing on MS prevalence in the Illawarra are required. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shoaib R Dal
- Department of Neurology, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Tiana-Lee Elphick
- Research Central, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Karen Fuller
- Department of Neurology, Wollongong Hospital, Wollongong, New South Wales, Australia
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Moral-Torres E, Fernández-Fernández Ó, Caballero-Martínez F, Carrascal-Rueda P, Monge-Martín D, Campos-Lucas FJ. Patient experience and self-perceived biopsychosocial burden of people living with multiple sclerosis: An epidemiological survey (BPS-MuScle study) in Spain. Mult Scler Relat Disord 2021; 56:103186. [PMID: 34455136 DOI: 10.1016/j.msard.2021.103186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Updated information on the self-perceived biopsychosocial burden and the healthcare experience among people living with multiple sclerosis in Spain is scarce.We aim to describe the self-reported disease experience of patients diagnosed with MS in Spain and to estimate their biopsychosocial burden. METHODS Multicentre epidemiological study based on a cross-sectional nationwide survey completed by a geographically stratified sample of MS patients in Spain. RESULTS A total of 490 surveys completed at 61 neurology units across Spain were analysed. Mean age was 43.7 ± 10.0 years (range:21-72), 71.4% were women. Most patients identified themselves as having relapsing-remitting MS (77.1%), 81.9% retained independent mobility. Most patients considered their health condition to be good (39.4%) or very good (13.1%). Mean EuroQoL questionnaire score was 69.2 ± 21.5. Most patients expressed high level of satisfaction with access to and quality of health care. However, 53.7% considered that sadness or depression interfered with their daily life. Concerns about social support were also mentioned. CONCLUSION Most people living with MS in Spain consider that their health condition is at least good but more psychological support and social protection measures are needed. Insights obtained from this study may help to better manage the condition in the future.
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Affiliation(s)
- Ester Moral-Torres
- Jefa del Servicio de Neurología. Hospital de Sant Joan Despí Moisès Broggi. Sant Joan Despí. Barcelona. Spain.
| | - Óscar Fernández-Fernández
- Profesor Honorario, Departamento de Farmacología, Facultad de Medicina, Universidad de Málaga, Spain; Investigador Senior, Instituto de Investigación Biomédica de Málaga (IBIMA), Spain; Hospital Regional Universitario de Málaga, Spain
| | - Fernando Caballero-Martínez
- Decano, Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain; Co-Director de la Cátedra de Inmunología UFV-Merck, Spain
| | | | - Diana Monge-Martín
- Vicedecana de Investigación y Educación Médica, Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain
| | - Francisco J Campos-Lucas
- Director de la Unidad de Consultoría y Salud, Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain
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Costa-Arpín E, Ares B, González-Quintela A, Prieto-González J. Temporal trends in the incidence and prevalence of Multiple Sclerosis in the Northwest of Spain. Mult Scler Relat Disord 2021; 52:102979. [PMID: 33964571 DOI: 10.1016/j.msard.2021.102979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND During the last decades, the frequency of multiple sclerosis (MS) is increasing worldwide. Nevertheless, the higher sensibility of the new diagnostic criteria obscures the comparison between studies performed in different decades. METHODS The evolution of the frequency of MS in Santiago de Compostela (North-West of Spain) between 2003 and 2015 was analyzed using Poisson regression. The diagnosis was confirmed according to Poser criteria. Several sources were consulted for case ascertainment: databases from the MS Unit, the Infusion Center, and the Departments of Neurology, Pharmacy, Pediatric Neurology and Codification of the public Hospital of Santiago, private hospitals, neurologists with private activity, general practitioners, and associations of patients. RESULTS In 12 years, the prevalence increased from 68 to 143 cases/100,000 inhabitants, from 83 to 176 in females; and from 49 to 106 in males (p <0.0001, 0.0001, and 0.0002 respectively). The incidence rise was not significant (from 5 to 8 cases/ 100,000 inhabitants/ year (p=0.4243). The mean age of the population growth 5.7 years (p=0.008). The changes in female: male ratio (12.9%), in the age at the first symptom (2.2 years), and the diagnosis delay (0.12 years) did not achieve significance (p=0.7750, 0.1606, 0.8581). CONCLUSION The prevalence of MS doubled in 12 years whilst the difference in incidence was lower and not significant. The disproportion in the growth of both parameters, as well as the higher mean age in the last study, suggest a longer survival of patients with MS.
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Affiliation(s)
- Eva Costa-Arpín
- Neurology Department, Hospital Clínico Universitario, Travesía da Choupana s/n, 15706, Santiago de Compostela, (A Coruña), Spain.
| | - Begoña Ares
- Neurology Department, Hospital Clínico Universitario, Travesía da Choupana s/n, 15706, Santiago de Compostela, (A Coruña), Spain
| | - Arturo González-Quintela
- Intern Medicine Department, Hospital Clínico Universitario, Travesía da Choupana s/n, 15706, Santiago de Compostela, (A Coruña), Spain
| | - José Prieto-González
- Neurology Department, Hospital Clínico Universitario, Travesía da Choupana s/n, 15706, Santiago de Compostela, (A Coruña), Spain
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Costa Arpín E, Naveiro Soneira J, Lema Bouzas M, González Quintela A, Prieto González JM. Epidemiology of multiple sclerosis in Santiago de Compostela (Spain). Acta Neurol Scand 2020; 142:267-274. [PMID: 32392359 DOI: 10.1111/ane.13265] [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: 12/10/2019] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To analyze the frequency and demographic characteristics of multiple sclerosis (MS) in the Council of Santiago de Compostela (SPAIN). MATERIAL AND METHODS The patients diagnosed with MS according to the McDonald 2010 diagnostic criteria were identified within the population of the District of Santiago de Compostela. Several sources were used (records and databases from Hospital, General Practitioners, Private Clinics, and the MS Patients Association). Demographic and clinical data were obtained from the electronic files. RESULTS The incidence of MS between 2010 and 2015 was 8/100 000/year (95% CI: 6-10), and the prevalence on December 31, 2015, was 152/100 000 (95% CI: 127-176). The age-standardized prevalence (using the European Standard Population 2013) was 137 (95% CI: 114-159) and the incidence of 7 (95% CI: 2-12). The female:male ratio was 1.84, the mean age at the first symptom was 32.23 years, the diagnosis was delayed 3.12 years, and the mean EDSS was 2.82. 71.17% had relapsing-remitting MS, 16.55% secondary progressive MS, 7.59% primary progressive MS, and 0.69% progressive relapsing MS. A disease-modifying treatment was established in 62.76% of patients in a mean of 1.96 years after the diagnosis. CONCLUSIONS The northwest of Spain is a high-risk area for MS, with frequencies similar to other Atlantic regions and higher than the rest of the country.
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Affiliation(s)
- Eva Costa Arpín
- Neurology Department Hospital Clínico Universitario de Santiago de Compostela Santiago de Compostela Spain
| | - Javier Naveiro Soneira
- Neurology Department Hospital Clínico Universitario de Santiago de Compostela Santiago de Compostela Spain
| | - Manuela Lema Bouzas
- Neurology Department Hospital Clínico Universitario de Santiago de Compostela Santiago de Compostela Spain
| | - Arturo González Quintela
- Intern Medicine Department Hospital Clínico Universitario de Santiago de Compostela Santiago de Compostela Spain
| | - José María Prieto González
- Neurology Department Hospital Clínico Universitario de Santiago de Compostela Santiago de Compostela Spain
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9
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Branco M, Alves I, Martins da Silva A, Pinheiro J, Sá MJ, Correia I, Sousa L, Brandão E, Veira C, Gomes B, Ruano L. The epidemiology of multiple sclerosis in the entre Douro e Vouga region of northern Portugal: a multisource population-based study. BMC Neurol 2020; 20:195. [PMID: 32429866 PMCID: PMC7236954 DOI: 10.1186/s12883-020-01755-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 04/30/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The prevalence of Multiple Sclerosis (MS) has been increasing worldwide and the north-south gradient of prevalence may be disappearing in the Northern hemisphere. The few previous prevalence studies performed in Portugal have reported a lower prevalence than the average for Western Europe. The aim of this study is to estimate the prevalence of MS in the Entre Douro e Vouga region, in Northern Portugal. METHODS Multiple overlapping sources were used to ascertain all cases from the reference population: records from hospitals in the region and neighbouring regions; diagnostic databases of primary care physicians; and applications for disability benefits. The prevalence date was set at 1 January 2014. The reference population was 274,859 inhabitants. Patients' neurologists were contacted to retrieve clinical information and confirm the diagnosis based. RESULTS A total of 177 patients were identified after eliminating duplicates from different sources. The female to male ratio was 1.9 and the mean age at disease onset was 33.5 (standard deviation: 10.3). Clinically isolated syndrome accounted for 9.0% of patients, relapsing remitting for 58.8%, secondary progressive for 20.3% and primary progressive for 11.8%. The prevalence was estimated in 64.4 patients per 100,000 (95% confidence interval: 54.9;73.9). CONCLUSIONS In this study we report a higher point prevalence of MS than had been previously described in Portugal, but still far from the higher values recently reported in other Southern European countries.
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Affiliation(s)
- Mariana Branco
- Serviço de Neurologia, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ivânia Alves
- Serviço de Neurologia, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Ana Martins da Silva
- Serviço de Neurologia Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Joaquim Pinheiro
- Serviço de Neurologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Maria José Sá
- Serviço de Neurologia, Centro Hospitalar de São João, Porto, Portugal.,Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal
| | - Inês Correia
- Serviço de Neurologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lívia Sousa
- Serviço de Neurologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Eva Brandão
- Serviço de Neurologia, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Carlos Veira
- Serviço de Neurologia, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Bernardo Gomes
- Unidade de Saúde Pública, ACES Entre Douro e Vouga I, Santa Maria da Feira, Portugal
| | - Luis Ruano
- Serviço de Neurologia, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal. .,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal. .,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
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Luetic G, Menichini ML. Multiple sclerosis prevalence in Santa Fe province, Argentina. Mult Scler Relat Disord 2020; 41:102006. [PMID: 32087592 DOI: 10.1016/j.msard.2020.102006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 10/25/2022]
Affiliation(s)
- G Luetic
- Instituto de Neurociencias de Rosario, Argentina
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11
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Moral Torres E, Fernández Fernández Ó, Carrascal Rueda P, Ruiz-Beato E, Estella Pérez E, Manzanares Estrada R, Gómez-García T, Jiménez M, Hidalgo-Vega Á, Merino M. Social value of a set of proposals for the ideal approach of multiple sclerosis within the Spanish National Health System: a social return on investment study. BMC Health Serv Res 2020; 20:84. [PMID: 32019531 PMCID: PMC7001370 DOI: 10.1186/s12913-020-4946-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease that in many cases produces disability, having a high impact in patients' lives, reducing significantly their quality of life. The aim of this study was to agree on a set of proposals to improve the current management of MS within the Spanish National Health System (SNHS) and apply the Social Return on Investment (SROI) method to measure the potential social impact these proposals would create. METHODS A Multidisciplinary Working Team of nine experts, with representation from the main stakeholders regarding MS, was set up to agree on a set of proposals to improve the management of MS. A forecast SROI analysis was carried out, with a one-year timeframe. Data sources included an expert consultation, a narrative literature review and a survey to 532 MS patients. We estimated the required investment of a hypothetical implementation, as well as the potential social value that it could create. We calculated outcomes in monetary units and we measured intangible outcomes through financial proxies. RESULTS The proposed ideal approach revealed that there are still unmet needs related to MS that can be addressed within the SNHS. Investment would amount to 148 million € and social return to 272 million €, so each euro invested could yield almost €2 of social return. CONCLUSIONS This study could guide health interventions, resulting in money savings for the SNHS and increases in patients' quality of life.
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Affiliation(s)
- Ester Moral Torres
- Neurology Service, Moisès Broggi Hospital - General Hospital of l'Hospitalet, Barcelona, Spain
| | | | | | | | | | | | | | - Margarita Jiménez
- Pharmacoeconomics and Market Access Department, Weber, Madrid, Spain
| | - Álvaro Hidalgo-Vega
- Economy and Health Research Seminar, Universidad de Castilla-La Mancha, Toledo, Spain
| | - María Merino
- Health Outcomes Research Department, Weber, Calle Moreto, 17, 5 Dcha, 28014, Madrid, Madrid, Spain.
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Pérez-Pérez S, Eguia Del Rio P, Domínguez-Mozo MI, García-Martínez MÁ, Zapata-Ramos MF, Torrejon MJ, Arroyo R, Alvarez-Lafuente R. Epidemiology of multiple sclerosis and vitamin D levels in Lanzarote, Canary Islands, Spain. PeerJ 2019; 7:e8235. [PMID: 31976164 PMCID: PMC6966995 DOI: 10.7717/peerj.8235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022] Open
Abstract
Background Low levels of 25-hydroxyvitamin D (25(OH)D) have been described as one of the possible environmental factors involved in multiple sclerosis (MS) etiopathogenesis. Objectives To study epidemiology of MS and 25(OH)D serum levels of patients in Lanzarote (29°02'06″N), a region with high ultraviolet radiation values during the whole year which is located far apart from Iberian Peninsula (36°-43°N), but without genetic/ethnic differences with it. Methods Incidence in Lanzarote was assessed according to McDonald 2005 criteria between January 2008 and December 2015 and prevalence date was 12/31/15. For 25(OH)D serum levels analyses, samples from 60 MS patients and 60 healthy donors (HD) were collected monthly in a one-year prospective study. Results The prevalence of MS in Lanzarote was 50.0/100,000 and the incidence per year was 2.5/100,000. Median 25(OH)D levels values were 29.1 ng/ml for MS patients (maximum = 36.1 ng/ml, minimum = 22.5 ng/ml) and 27.1 ng/ml for HD (maximum = 34.8 ng/ml, minimum = 22.8 ng/ml). There were no significant differences between 25(OH)D serum levels between MS patients and HD. Conclusions Lanzarote possesses lower prevalence and incidence values than peninsular Spain. Moreover, 25(OH)D serum levels do not differ between MS patients and HD.
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Affiliation(s)
- Silvia Pérez-Pérez
- Grupo de Investigación de Factores Ambientales en Enfermedades Degenerativas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | | | - María Inmaculada Domínguez-Mozo
- Grupo de Investigación de Factores Ambientales en Enfermedades Degenerativas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - María Ángel García-Martínez
- Grupo de Investigación de Factores Ambientales en Enfermedades Degenerativas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | | | - Maria Jose Torrejon
- Servicio de Análisis Clínicos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Rafael Arroyo
- Servicio de Neurología, Hospital Universitario Quirónsalud Madrid, Madrid, Spain
| | - Roberto Alvarez-Lafuente
- Grupo de Investigación de Factores Ambientales en Enfermedades Degenerativas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
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13
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Multiple sclerosis prevalence and incidence in San Vicente del Raspeig, Spain. Mult Scler Relat Disord 2019; 33:78-81. [DOI: 10.1016/j.msard.2019.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/25/2019] [Accepted: 05/28/2019] [Indexed: 12/31/2022]
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Martínez-Ginés ML, García-Domínguez JM, Forero L, Canal N, Rebollo P, Prefasi D, Honan CA, Maurino J. Spanish validation of a specific measure to assess work-related problems in people with multiple sclerosis: The Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ-23). Mult Scler Relat Disord 2018; 22:115-119. [DOI: 10.1016/j.msard.2018.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/02/2018] [Indexed: 01/30/2023]
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Fernández-Muñoz JJ, Cigarán-Méndez M, Navarro-Pardo E, Pérez-de-Heredia-Torres M, Parás-Bravo P, Fernández-de-las-Peñas C. Is the association between health-related quality of life and fatigue mediated by depression in patients with multiple sclerosis? A Spanish cross-sectional study. BMJ Open 2018; 8:e016297. [PMID: 29362245 PMCID: PMC5786117 DOI: 10.1136/bmjopen-2017-016297] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To determine the mediating effects of depression on health-related quality of life and fatigue in individuals with multiple sclerosis (MS). DESIGN A cross-sectional study. SETTING Tertiary urban hospital. PARTICIPANTS One hundred and eight patients (54% women) with MS participated in this study. OUTCOME MEASURES Demographic and clinical data (weight, height, medication and neurological impairment), fatigue (Fatigue Impact Scale), depression (Beck Depression Inventory-II) and health-related quality of life (Short-Form Health Survey 36) were collected. RESULTS Fatigue was significantly associated with bodily pain, physical function, mental health and depression. Depression was associated with bodily pain and mental health. The path analysis found direct effects from physical function, bodily pain and depression to fatigue (all, P<0.01). The path model analysis revealed that depression exerted a mediator effect from bodily pain to fatigue (B=-0.04, P<0.01), and from mental health to fatigue (B=-0.16, P<0.01). The amount of fatigue explained by all predictors in the path model was 37%. CONCLUSIONS This study found that depression mediates the relationship between some health-related quality of life domains and fatigue in people with MS. Future longitudinal studies focusing on proper management of depressive symptoms in individuals with MS will help determine the clinical implications of these findings.
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Affiliation(s)
| | | | - Esperanza Navarro-Pardo
- Departamento de Psicología Evolutiva y de la Educación, Universitat de Valencia, Valencia, Comunitat Valenciana, Spain
| | - Marta Pérez-de-Heredia-Torres
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Paula Parás-Bravo
- Department of Nursing, Universidad de Cantabria, Santander, Cantabria, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Sicras-Mainar A, Ruíz-Beato E, Navarro-Artieda R, Maurino J. Impact on healthcare resource utilization of multiple sclerosis in Spain. BMC Health Serv Res 2017; 17:854. [PMID: 29284493 PMCID: PMC5747126 DOI: 10.1186/s12913-017-2807-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/15/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disease with a high socioeconomic impact. The aim of this study was to assess healthcare resources utilization and costs in a sample of patients with MS. METHODS A retrospective, cohort study was conducted using electronic medical records from 19 primary care centres in Asturias and Catalonia, Spain. Adult patients diagnosed with MS were distributed into two groups according to the Expanded Disability Status Scale (EDSS) score: 0-3.5 (no-moderate disability) and 4-9.5 (severe disability). Healthcare (direct cost) and non-healthcare costs (work productivity losses) were analysed. An analysis of covariance (ANCOVA) was used for correction, p < 0.05. A multiple regression model was performed to obtain the variables associated with costs. RESULTS A total of 222 patients were analyzed; mean (SD) age: 45.5 (12.5) years, 64.4% female, and 62.2% presented a diagnosis of relapsing-remitting MS. Median EDSS score was 2.5, with 68.5% of the patients with no to moderate disability. The mean annual cost per MS patient was €25,103. For no-moderate and severe disability, the ANCOVA-adjusted mean annual cost was €23,157 and €29,242, respectively (p = 0.013). Direct costs and MS disease-modifying therapy accounted for 39.4% and 31.7% of the total costs, respectively. The total costs were associated with number of relapses (β = 0.135, p = 0.001), time since diagnosis (β = 0.281, p = 0.023), and age (β = 0.198, p = 0.037). CONCLUSIONS Multiple sclerosis imposes a substantial economic burden on the Spanish National Health System, patients and society as a whole. Costs significantly correlated with disease progression.
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Affiliation(s)
- Antoni Sicras-Mainar
- Fundación Rediss (Red de Investigación en Servicios Sanitarios), Barcelona, Spain
| | - Elena Ruíz-Beato
- Health Economics and Outcomes Research Unit, Roche Farma, Madrid, Spain
| | - Ruth Navarro-Artieda
- Department of Medical Information, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jorge Maurino
- Medical Department, Roche Farma, Madrid, Spain. .,, Madrid, Spain.
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17
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Fernández O, Calleja-Hernández MA, Meca-Lallana J, Oreja-Guevara C, Polanco A, Pérez-Alcántara F. Estimate of the cost of multiple sclerosis in Spain by literature review. Expert Rev Pharmacoecon Outcomes Res 2017; 17:321-333. [PMID: 28726515 DOI: 10.1080/14737167.2017.1358617] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Multiple Sclerosis (MS) is a progressive disease leading to increasing disability and costs. A literature review was carried out to identify MS costs and to estimate its economic burden in Spain. Areas Covered: The public electronic databases PubMed, ScienceDirect and IBECS were consulted and a manual review of communications presented at related congresses was carried out. A total of 225 references were obtained, of which 43 were finally included in the study. Expert Commentary: Three major cost groups were identified: direct healthcare costs, direct non-healthcare costs and indirect costs. There is a direct relationship between disease progression and increased costs, mainly direct non-healthcare costs (greater need for informal care) and indirect costs (greater loss of productivity). The total cost associated with MS in Spain is €1,395 million per year, and that the mean annual cost per patient is €30,050. Beyond costs, a large impact on the quality of life of patients, with an annual loss of up to 13,000 quality-adjusted life years was also estimated. MS has a large economic impact on Spanish society and a significant impact on the quality of life of patients.
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Affiliation(s)
- Oscar Fernández
- a Instituto de Investigación Biomédica de Málaga , Hospital Regional Universitario de Málaga , Málaga , Spain
| | | | - José Meca-Lallana
- c Multiple Sclerosis Unit, Department of Neurology , Hospital Clínico Universitario Virgen de la Arrixaca , Murcia , Spain
| | | | - Ana Polanco
- e Market Access and Corporate Affairs , Merck Group , Madrid , Spain
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18
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Sicras-Mainar A, Ruíz-Beato E, Navarro-Artieda R, Maurino J. Comorbidity and metabolic syndrome in patients with multiple sclerosis from Asturias and Catalonia, Spain. BMC Neurol 2017; 17:134. [PMID: 28716070 PMCID: PMC5512748 DOI: 10.1186/s12883-017-0914-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/09/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The impact of comorbidity on multiple sclerosis (MS) is a new area of interest. Limited data on the risk factors of metabolic syndrome (MetS) is currently available. The aim of this study was to estimate the presence of comorbid conditions and MetS in a sample of adult patients with MS. METHODS A retrospective, cohort study was conducted using electronic medical records from 19 primary care centres in Catalonia and Asturias, Spain. The number of chronic diseases (diagnoses), the Charlson Comorbidity Index and the individual Case-mix Index were used to assess general comorbidity variables. MetS was defined using the National Cholesterol Education Program Adult Treatment Panel III. Patients were distributed into two groups according to the Expanded Disability Status Scale (EDSS) score: 0-3.5 and 4-10. RESULTS A total of 222 patients were studied (mean age = 45.5 (SD 12.5) years, 64.4% were female and 62.2% presented a diagnosis of relapsing-remitting MS). Mean EDSS score was 3.2 (SD 2.0). Depression (32.4%), dyslipidaemia (31.1%), hypertension (23.0%) and obesity (22.5%) were the most common comorbidities. Overall MetS prevalence was 31.1% (95% CI: 25.0-37.2%). Patients with an EDSS ≥ 4.0 showed a significantly higher number of comorbidities (OR=2.2; 95% CI: 1.7-3.0; p<0.001). CONCLUSION MS patients had a high prevalence of MetS. Screening for comorbidity should be part of standard MS care. Further studies are necessary to confirm this association and the underlying mechanisms of MS and its comorbidities.
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Affiliation(s)
- Antoni Sicras-Mainar
- Fundación Rediss (Red de Investigación en servicios Sanitarios), Barcelona, Spain
| | - Elena Ruíz-Beato
- Health Economics and Outcomes Research Unit, Roche Farma S.A., Madrid, Spain
| | - Ruth Navarro-Artieda
- Department of Medical Information, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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Abstract
Novel epidemiological data have appeared in recent years in Latin America (LATAM). The objective of this study was to perform an updated systematic review of the epidemiology of the disease reported in LATAM.
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Affiliation(s)
| | - Juan Ignacio Rojas
- Department of Neurology, MS Clinic, Hospital Italiano de Buenos Aires, Argentina
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20
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Abstract
Multiple sclerosis is characterized by a non-homogeneous distribution around the world. Some authors in past described a latitude gradient, with increasing risk from the equator to North and South Poles, but this theory is still controversial. Regarding Europe, there are many articles in the literature concerning the epidemiology of this disease but, unfortunately, they are not always comparable due to different methodologies, they do not cover all countries in the continent, and most of them reported data of small areas and rarely at a national level. In 2012 there were 20 national registries that could help to describe the epidemiology of the disease and, in addition, there is an European Register for Multiple Sclerosis that collect data from already existing national or regional MS registries and databases. Another valid alternative to obtain epidemiological data, also at national level, in a routinely and cost-saving way is through administrative data that are of increasing interest in the last years.
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Cristiano E, Patrucco L, Miguez J, Giunta D, Correale J, Fiol M, Ysrraelit M, Cáceres F, Liguori NF, Saladino M, Garcea O, Silva B, Alonso R, Carrá A, Curbelo M, Martinez A, Steinberg J, Giachello S, Melcom M, Rojas J. Increasing prevalence of multiple sclerosis in Buenos Aires, Argentina. Mult Scler Relat Disord 2016; 9:91-4. [DOI: 10.1016/j.msard.2016.07.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 12/23/2022]
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22
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Candeliere-Merlicco A, Valero-Delgado F, Martínez-Vidal S, Lastres-Arias MDC, Aparicio-Castro E, Toledo-Romero F, Villaverde-González R. Prevalence of multiple sclerosis in Health District III, Murcia, Spain. Mult Scler Relat Disord 2016; 9:31-5. [DOI: 10.1016/j.msard.2016.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
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23
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Fernández O, Arroyo R, Martínez-Yélamos S, Marco M, Merino JAG, Muñoz D, Merino E, Roque A. Long-Term Adherence to IFN Beta-1a Treatment when Using RebiSmart® Device in Patients with Relapsing-Remitting Multiple Sclerosis. PLoS One 2016; 11:e0160313. [PMID: 27526201 PMCID: PMC4985132 DOI: 10.1371/journal.pone.0160313] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/18/2016] [Indexed: 12/26/2022] Open
Abstract
The effectiveness of disease-modifying drugs in the treatment of multiple sclerosis is associated with adherence. RebiSmart® electronic device provides useful information about adherence to the treatment with subcutaneous (sc) interferon (IFN) β-1a (Rebif®). The aim of the study was to determine long-term adherence to this treatment in patients with relapsing-remitting multiple sclerosis (RRMS). This retrospective multicentre observational study analysed 258 patients with RRMS who were receiving sc IFN β-1a (Rebif®) treatment by using RebiSmart® until replacement (36 months maximum lifetime) or treatment discontinuation. Adherence was calculated with data (injection dosage, time, and date) automatically recorded by RebiSmart®. Patients in the study had a mean age of 41 years with a female proportion of 68%. Mean EDSS score at start of treatment was 1.8 (95% CI, 1.6-1.9). Overall adherence was 92.6% (95% CI, 90.6-94.5%). A total of 30.2% of patients achieved an adherence rate of 100%, 80.6% at least 90%, and only 13.2% of patients showed a suboptimal adherence (<80%). A total of 59.9% of subjects were relapse-free after treatment initiation. Among 106 subjects (41.1%) who experienced, on average, 1.4 relapses, the majority were mild (40.6%) or moderate (47.2%). Having experienced relapses from the beginning of the treatment was the only variable significantly related to achieving an adherence of at least 80% (OR = 3.06, 1.28-7.31). Results of this study indicate that sc IFN β-1a administration facilitated by RebiSmart® could lead to high rates of adherence to a prescribed dose regimen over 36 months.
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Affiliation(s)
- O. Fernández
- Hospitales Universitarios Regional de Málaga y Virgen de la Victoria, Universidad de Málaga, IBIMA
| | - R. Arroyo
- Hospital U. Clínico San Carlos, Madrid
| | | | - M. Marco
- Corporació Sanitaria Parc Taulí, Barcelona
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Fiest KM, Marrie RA, Jette N, Bennett DA. The Standards of Reporting of Neurological Disorders (STROND) checklist: Application to multiple sclerosis. Mult Scler 2016; 23:23-33. [DOI: 10.1177/1352458516634873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: Descriptive epidemiological studies documenting the incidence and prevalence of multiple sclerosis (MS) and studies that report morbidity, mortality, and economic burden provide essential information for patients, healthcare providers, and policymakers. However, the quality of reporting of observational studies is often poor, limiting the ability to evaluate the validity of the findings. The Standards of Reporting of Neurological Disorders (STROND) reporting guideline comprises recommendations and a 15-item checklist of reporting items to aid high-quality reporting of incidence and prevalence studies of neurological disorders. Methods: We explain the basic reporting items of the STROND checklist for the methods, results, and discussion sections in the context of the MS literature and searched for examples of good reporting of those items. Results: We identified examples of good reporting of the basic reporting items from previous systematic reviews of the descriptive epidemiologic literature in MS. Conclusion: The adoption of the STROND reporting guidelines should improve the quality of reporting of descriptive epidemiological studies in MS. Along with efforts to improve methodological aspects of epidemiological studies and harmonization of data collection efforts, improved reporting could contribute to furthering our understanding of the epidemiology of MS.
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Affiliation(s)
- Kirsten M Fiest
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Health Sciences Center, Winnipeg, MB, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Health Sciences Center, Winnipeg, MB, Canada / Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Nathalie Jette
- Department of Community Health Sciences and O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada / Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Derrick A Bennett
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Leray E, Moreau T, Fromont A, Edan G. Epidemiology of multiple sclerosis. Rev Neurol (Paris) 2016; 172:3-13. [DOI: 10.1016/j.neurol.2015.10.006] [Citation(s) in RCA: 223] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/05/2015] [Accepted: 10/08/2015] [Indexed: 11/17/2022]
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Otero-Romero S, Ramió-Torrentà L, Pericot I, Carmona O, Perkal H, Saiz A, Bufill E, Robles R, Simón E, Llufriu S, Vaqué-Rafart J, Sastre-Garriga J, Montalban X. Onset-adjusted incidence of multiple sclerosis in the Girona province (Spain): Evidence of increasing risk in the south of Europe. J Neurol Sci 2015; 359:146-50. [PMID: 26671104 DOI: 10.1016/j.jns.2015.10.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/25/2015] [Accepted: 10/25/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recent studies show an increasing incidence of multiple sclerosis (MS) in southern Europe. Although by its geographical location and genetic characteristics Spain is expected to be similar to other southern European regions, data on incidence are scarce. The aim of this study was to determine the onset-adjusted incidence of MS in the Girona province in Catalonia (Spain). METHODS A prospective incidence study pooling data from the population-based Catalonia MS Registry was performed. Incident cases were defined as patients who had the onset of symptoms compatible with a clinically isolated syndrome (CIS) suggestive of MS in 2009 and fulfilled McDonald-2005 criteria during follow-up. Age- and sex-specific incidence rates were obtained. RESULTS The Registry included 182 patients residing in Girona that presented a CIS from January 2009 to December 2013. Fifty one patients had the onset of symptoms in 2009, of whom 27 patients fulfilled the diagnostic criteria, giving an incidence of 3.6 per 100,000 (CI 95% 2.4-5.3) inhabitants; 4.3 (CI 95% 2.5-7.1) for women and 2.9 (CI 95% 1.4-5.2) for men. The age-adjusted incidence rate for the European population was 3.29 (CI 95% 3.2-3.3). CONCLUSION The incidence estimation derived in this study is consistent with recent epidemiological data of MS in southern Europe suggesting an increase in incidence in this region.
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Affiliation(s)
- S Otero-Romero
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d'Hebron University Hospital, Barcelona, Spain; Preventive Medicine and Epidemiology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Ll Ramió-Torrentà
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Dr. Josep Trueta University Hospital, Neurodegeneration and Neuroinflammation Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - I Pericot
- Hospital Santa Caterina, Girona, Spain
| | | | - H Perkal
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Dr. Josep Trueta University Hospital, Neurodegeneration and Neuroinflammation Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - A Saiz
- Center of Neuroimmunology, Neurology Service, Hospital Clinic, Barcelona, Spain
| | - E Bufill
- Neurology Department, Hospital General de Vic, Barcelona, Spain
| | - R Robles
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Dr. Josep Trueta University Hospital, Neurodegeneration and Neuroinflammation Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - E Simón
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - S Llufriu
- Center of Neuroimmunology, Neurology Service, Hospital Clinic, Barcelona, Spain
| | - J Vaqué-Rafart
- Preventive Medicine and Epidemiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - J Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - X Montalban
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology-Neuroimmunology, Vall d'Hebron University Hospital, Barcelona, Spain
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Sánchez-de la Rosa R, García-Bujalance L, Meca-Lallana J. Cost analysis of glatiramer acetate versus interferon-β for relapsing-remitting multiple sclerosis in patients with spasticity: the Escala study. HEALTH ECONOMICS REVIEW 2015; 5:30. [PMID: 26475277 PMCID: PMC4608957 DOI: 10.1186/s13561-015-0066-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 10/08/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The Escala Study evidenced that the administration of glatiramer acetate for relapsing-remitting multiple sclerosis improved the spasticity of patients previously treated with interferon-β. However, whether such an improvement was translated into cost savings remained unclear. We therefore conducted a cost analysis of glatiramer acetate versus interferon-β in these patients with multiple sclerosis and spasticity. METHODS This cost analysis encompassed data from the observational Escala Study, which included patients with relapsing-remitting multiple sclerosis and spasticity whose treatment had been switched from interferon-β to glatiramer acetate. Costs prior to starting glatiramer acetate (interferon-β period) were compared to the subsequent six months on glatiramer acetate (glatiramer acetate period). The analysis was carried out following the recommendations for conducting pharmacoeconomic studies and from the Spanish National Health System perspective. Costs associated with multiple sclerosis treatment, spasticity treatment and relapse management were expressed in 2014 euros (€); a 7.5 % discount was applied-when needed-as stipulated in Spanish law. RESULTS The management of relapsing-remitting multiple sclerosis, spasticity and relapses accounted for a 6-month cost per patient of 7,078.02€ when using interferon-β and 4,671.31€ when using glatiramer acetate. Switching from interferon-β to glatiramer acetate therefore represented a cost saving of 2,406.72€ per patient in favour of glatiramer acetate, which resulted from savings in treatment costs, relapse management and spasticity treatment of 1,890.02€, 430.48€ and 86.21€, respectively. The ratio of the costs during interferon-β was 1.5 times the costs during glatiramer acetate; thus, a fixed budget of 5,000,000€ would enable 1,070 patients to be treated with glatiramer acetate and only 706 patients with interferon-β. CONCLUSIONS The treatment of relapsing-remitting multiple sclerosis with glatiramer acetate entailed cost savings when compared to interferon-β in patients with spasticity, which not only resulted from its lower costs of therapy and relapse management but also from its favourable effect on reducing spasticity. Thus, glatiramer acetate may be regarded as a more efficient alternative than interferon-β from the perspective of the Spanish National Health System.
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Affiliation(s)
| | - Laura García-Bujalance
- Market Access & Regulatory Department, TEVA Pharmaceutical, Calle de Anabel Segura, 11, 28108, Madrid, Spain.
| | - José Meca-Lallana
- Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Carretera Madrid-Cartagena, S/N, 30120, El Palmar, Spain.
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Bártulos Iglesias M, Marzo Sola M, Estrella Ruiz L, Bravo Anguiano Y. Estudio epidemiológico de la esclerosis múltiple en La Rioja. Neurologia 2015; 30:552-60. [DOI: 10.1016/j.nrl.2014.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 03/10/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022] Open
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Izquierdo G, Venegas A, Sanabria C, Navarro G. Long-term epidemiology of multiple sclerosis in the Northern Seville District. Acta Neurol Scand 2015; 132:111-7. [PMID: 25649860 PMCID: PMC5024007 DOI: 10.1111/ane.12363] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Comprehensive epidemiologic data for multiple sclerosis (MS) in Spain are limited. The aim of this study was to collect epidemiologic data on MS in the Northern Seville District of Spain. MATERIALS AND METHODS This longitudinal study identified possible MS cases every year from nine centres between 1 January 1991 and 31 December 2011. Patients with a confirmed diagnosis of MS were included. MS data prior to enrolment were collected retrospectively from clinical records and prospectively during quarterly follow-up clinic visits. Variables included age at onset, age at diagnosis, treatment, follow-up duration, number of visits, number of relapses, change in the number of relapses over time and Expanded Disability Status Scale score. The incidence and prevalence of MS rate were calculated. RESULTS Overall, 156 patients with MS were identified (111 females; mean follow-up 7.5 years). Most patients had relapsing-remitting MS (73.7%); primary progressive disease was less frequent than secondary disease (10.9% vs 15.4%). The yearly incidence of MS was 4.6 per 100,000, and the prevalence at 31 December 2011 was 90.2 per 100,000. CONCLUSIONS The annual MS incidence rate in this southern region of Spain was higher than previously reported rates in Spanish studies.
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Affiliation(s)
- Guillermo Izquierdo
- Unidad de Esclerosis Múltiple Servicio de Neurología Hospital Universitario Virgen Macarena Sevilla Spain
| | - Ana Venegas
- Unidad de Esclerosis Múltiple Servicio de Neurología Hospital Universitario Virgen Macarena Sevilla Spain
| | - Carmen Sanabria
- Unidad de Esclerosis Múltiple Servicio de Neurología Hospital Universitario Virgen Macarena Sevilla Spain
| | - Guillermo Navarro
- Unidad de Esclerosis Múltiple Servicio de Neurología Hospital Universitario Virgen Macarena Sevilla Spain
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de Sá J, Alcalde-Cabero E, Almazán-Isla J, García-López F, de Pedro-Cuesta J. Incidence of multiple sclerosis in Northern Lisbon, Portugal: 1998-2007. BMC Neurol 2014; 14:249. [PMID: 25528357 PMCID: PMC4300835 DOI: 10.1186/s12883-014-0249-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/11/2014] [Indexed: 12/15/2022] Open
Abstract
Background There are few, recent, well assessed, multiple sclerosis (MS) incidence surveys on European populations. This study sought to measure MS incidence in a Northern Lisbon population and assess it using capture-recapture methods (CRMs). Methods Among the population residing in the Northern Lisbon Health Area, registered MS diagnoses were obtained from general practitioners in three primary-care districts covering a population of 196,300, and a neurology unit at the main referral hospital. Cases with onset during the periods 1978–1997 and 2008–2012 were excluded due to perceived poor access to image-supported neurological diagnosis and administrative changes in patient referral respectively. Age- and sex-specific incidences for the period 1998–2007 were calculated using McDonald diagnostic criteria, and CRMs were used to correct age-specific incidence rates. The corrected figures were also adjusted for age using the European Standard Population as reference. Results When applied to 62 MS patients with onset in the period 1998–2007, the rates per 100,000 population were as follows for both sexes: crude, 3.16; age-adjusted, 3.09 (95% CI 2.32 to 3.87); CRM-adjusted, 4.53 (95% CI 3.13 to 5.94); and age- and CRM-adjusted, 4.48 (3.54-5.41). In general, the rates were 3-fold higher among women than among men. Negative source dependency and CRM impact were highest at ages 35–44 years, where a 60% rise led to a peak incidence. Conclusions MS incidence in Northern Lisbon, Portugal, is moderately lower than that yielded by surveys on European populations. CRMs, which in this instance suggest undercounts, are a potentially useful tool for case-finding assessment but their application may introduce bias.
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Affiliation(s)
- Joao de Sá
- Neurology Department, Santa Maria Hospital, Av Prof. Egas Moniz, Lisbon, 1600-001, Portugal.
| | - Enrique Alcalde-Cabero
- National Centre for Epidemiology, Carlos III Institute of Health, Av Monforte de Lemos, 5, 28029, Madrid, Spain. .,Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Ministry of Economy and Competitiveness, Madrid, Spain.
| | - Javier Almazán-Isla
- National Centre for Epidemiology, Carlos III Institute of Health, Av Monforte de Lemos, 5, 28029, Madrid, Spain. .,Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Ministry of Economy and Competitiveness, Madrid, Spain.
| | - Fernando García-López
- National Centre for Epidemiology, Carlos III Institute of Health, Av Monforte de Lemos, 5, 28029, Madrid, Spain. .,Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Ministry of Economy and Competitiveness, Madrid, Spain.
| | - Jesús de Pedro-Cuesta
- National Centre for Epidemiology, Carlos III Institute of Health, Av Monforte de Lemos, 5, 28029, Madrid, Spain. .,Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Ministry of Economy and Competitiveness, Madrid, Spain. .,Department Epidemiología Aplicada - CIBERNED, Centro Nacional de Epidemiología, Pab 12, Instituto Salud Carlos III, Av/ Monforte de Lemos 5, 28029, Madrid, Spain.
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Melcon MO, Correale J, Melcon CM. Is it time for a new global classification of multiple sclerosis? J Neurol Sci 2014; 344:171-81. [PMID: 25062946 DOI: 10.1016/j.jns.2014.06.051] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/09/2014] [Accepted: 06/24/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The geographic distribution of multiple sclerosis (MS) is classically divided into three zones based on frequency that were established by Kurtzke in the early 1970s. In recent years, an increasing number of epidemiological studies have shown significantly higher MS prevalence and incidence rates. OBJECTIVE The aim of this study was to review and update the geographic distribution of MS using incidence, prevalence and disease duration from the latest epidemiology surveys. METHODS We conducted a systematic review of articles on MS epidemiology published between January 1, 1990 and December 31, 2012. RESULTS MS studies were grouped by continent: the Americas, Europe, Asia, Australia/New Zealand, and Africa. A total of 101 studies were identified according to the inclusion criteria, and 58 reported incidence estimates. Globally, the median estimated incidence of MS was 5.2 (range: 0.5-20.6) per 100,000 p-yrs, the median estimated prevalence of MS was 112.0 (with a range of 5.2-335) per 100,000 p-yrs, and the average disease duration was 20.2 years (range: 7.6-36.2). CONCLUSION In the past few decades, the global prevalence and incidence patterns of MS have changed dramatically. Regardless of the reason of increasing prevalence and incidence rate, we suggest the need for a novel classification system based on global MS disease burden. Adopting such a system would improve economic efficiency and prioritization in health policy planning for MS.
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Affiliation(s)
- Mario O Melcon
- Foundation for Neuroepidemiology Research, Junín, Buenos Aires Province, Argentina.
| | - Jorge Correale
- Department of Neurology, Institute for Neurological Research Dr. Raúl Carrea, FLENI, Buenos Aires, Argentina
| | - Carlos M Melcon
- Foundation for Neuroepidemiology Research, Junín, Buenos Aires Province, Argentina
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Ablah E, Hesdorffer DC, Liu Y, Paschal AM, Hawley S, Thurman D, Hauser WA. Prevalence of epilepsy in rural Kansas. Epilepsy Res 2014; 108:792-801. [DOI: 10.1016/j.eplepsyres.2014.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 12/09/2013] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
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Cost minimisation analysis of fingolimod vs. natalizumab as a second line of treatment for relapsing-remitting multiple sclerosis. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2013.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Limmroth V. Treatment of Relapsing-Remitting Multiple Sclerosis: Current and Future Algorithms. Eur Neurol 2014; 72 Suppl 1:35-8. [DOI: 10.1159/000367624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Crespo C, Izquierdo G, García-Ruiz A, Granell M, Brosa M. Cost minimisation analysis of fingolimod vs natalizumab as a second line of treatment for relapsing-remitting multiple sclerosis. Neurologia 2013; 29:210-7. [PMID: 24161412 DOI: 10.1016/j.nrl.2013.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 04/03/2013] [Accepted: 04/06/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION At present, there is a lack of economic assessments of second-line treatments for relapsing-recurring multiple sclerosis. The aim of this study was to compare the efficiency between fingolimod and natalizumab in Spain. METHODS A cost minimisation analysis model was developed for a 2-year horizon. The same relapse rate was applied to both treatment arms and the cost of resources was calculated using Spain's stipulated rates for 2012 in euros. The analysis was conducted from the perspective of Spain's national health system and an annual discount rate of 3% was applied to future costs. A sensitivity analysis was performed to validate the robustness of the model. RESULTS Indirect comparison of fingolimod with natalizumab revealed no significant differences (hazard ratio between 0.82 and 1.07). The total direct cost, considering a 2-year analytical horizon, a 7.5% discount stipulated by Royal Decree, and a mean annual relapse rate of 0.22, was € 40914.72 for fingolimod and € 45890.53 for natalizumab. Of the total direct costs that were analysed, the maximum cost savings derived from prescribing fingolimod prescription was € 4363.63, corresponding to lower administration and treatment maintenance costs. Based on the sensitivity analysis performed, fingolimod use was associated with average savings of 11% (range 3.1%-18.7%). CONCLUSIONS Fingolimod is more efficient than natalizumab as a second-line treatment option for relapsing-remitting multiple sclerosis and it generates savings for the Spanish national health system.
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Affiliation(s)
- C Crespo
- Departamento de Estadística, Universidad de Barcelona, Barcelona, España; Oblikue Consulting, Barcelona, España.
| | - G Izquierdo
- Unidad de Esclerosis Múltiple, Hospital Universitario Virgen de la Macarena, Sevilla, España
| | - A García-Ruiz
- Departamento de Farmacología y Terapéutica Clínica, Facultad de Medicina, Universidad de Málaga, Málaga, España
| | - M Granell
- Novartis Farmacéutica, Barcelona, España
| | - M Brosa
- Oblikue Consulting, Barcelona, España
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Sanchez-de la Rosa R, Sabater E, Casado MA. Cost analysis of glatiramer acetate vs. fingolimod for the treatment of patients with relapsing-remitting multiple sclerosis in Spain. HEALTH ECONOMICS REVIEW 2013; 3:13. [PMID: 23647721 PMCID: PMC3651713 DOI: 10.1186/2191-1991-3-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 05/03/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Fingolimod is an innovative drug with a significant budget impact in the treatment of MS in Spain. The aim of this study was to calculate the direct cost comparison of glatiramer acetate and fingolimod for the treatment of patients with relapsing-remitting multiple sclerosis (RRMS) in Spain. METHODS A cost analysis model was developed to compare glatiramer acetate and fingolimod, based on a 1-year time horizon. In addition to the pharmacological costs, resource use was estimated for glatiramer acetate (1 hour of training with nursing staff in self-injection techniques for subcutaneous administration) and fingolimod (vaccination for varicella-zoster virus in 5% of patients, 3 complete blood counts per year, 3 ophthalmology visits for prevention of macular edema, 3 transaminase tests to monitor liver function, and cardiovascular monitoring consisting of 1 ECG before the first fingolimod dose and at 6 hours; 1 day outpatients-hospital visit for cardiological monitoring during 6 hours on the day of the first fingolimod dose, with follow-up of blood pressure and heart rate every hour). The pharmacological costs were calculated based on the ex-factory price of the drugs evaluated, using the doses recommended in the respective Summary of Products Characteristics (SmPC). Total invoicing volume was discounted by 7.5%, as laid down in Spanish Royal Decree 8/2010. Unit costs were obtained from the e-Salud database and the drug catalog. Costs in the model are expressed in €2012. RESULTS The cost of annual treatment was €9,439.42 for glatiramer acetate and €19,602.18 for fingolimod, yielding a cost difference of €10,162.76. Assuming a fixed budget of €100,000.00, approximately 10 patients could be treated with glatiramer acetate, compared to 5 with fingolimod. CONCLUSIONS Fingolimod therapy requires twice the investment as glatiramer acetate.
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Affiliation(s)
- Rainel Sanchez-de la Rosa
- Medical & HEOR Department, TEVA Pharmaceutical, Calle Anabel Segura, 11-1ª planta, Alcobendas, Madrid, 28108, Spain
| | - Eliazar Sabater
- Pharmacoeconomics and Outcomes Research Iberia Edificio CEP Altagracia I Calle Segundo Mata, 1 (2ª Planta), Pozuelo de Alarcón, Madrid, 28224, Spain
| | - Miguel A Casado
- Pharmacoeconomics and Outcomes Research Iberia Edificio CEP Altagracia I Calle Segundo Mata, 1 (2ª Planta), Pozuelo de Alarcón, Madrid, 28224, Spain
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de Sá J, Alcalde-Cabero E, Almazán-Isla J, Sempere A, de Pedro-Cuesta J. Capture-Recapture as a Potentially Useful Procedure for Assessing Prevalence of Multiple Sclerosis: Methodologic Exercise Using Portuguese Data. Neuroepidemiology 2012; 38:209-16. [DOI: 10.1159/000337534] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 02/25/2012] [Indexed: 11/19/2022] Open
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