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Sainz de la Maza S, Maurino J, Borges M, Martín-Martínez J, Sotoca J, Alonso A, Caminero AB, Borrega L, Sánchez-Menoyo JL, Barrero-Hernández FJ, Calles C, Brieva L, Blasco MR, García-Soto JD, Campo-Amigo MD, Navarro-Cantó L, Agüera E, Garcés M, Carmona O, Gabaldón-Torres L, Forero L, Hervás M, de Alda LR, Gómez-Ballesteros R, Castillo-Triviño T. Measuring productivity loss in early relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2022; 58:103398. [PMID: 35216781 DOI: 10.1016/j.msard.2021.103398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/08/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Multiple sclerosis is one of the most common causes of neurological disability in young adults with major consequences for their autonomy and capacity to maintain employment. OBJECTIVE The aim of this study was to assess the impact on work productivity in early-stage relapsing-remitting multiple sclerosis (RRMS). METHODS A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0-5.5 were included. Absenteeism, presenteeism, and unpaid work loss due to RRMS were measured using the Valuation of Lost Productivity (VOLP) questionnaire. The EDSS, SymptoMScreen, 5-item Modified Fatigue Impact Scale, Hospital Anxiety and Depression Scale, Symbol Digit Modalities Test, and Multiple Sclerosis Work Difficulties Questionnaire were used to gather information on disability, patients' perception of symptom severity, fatigue, mood/anxiety, cognition, and problems in the workplace, respectively. Associations between the VOLP and clinical and work outcomes were analyzed using Spearman's rank correlations. RESULTS A total of 189 patients were included. Mean age (SD) was 36.1 ± 9.4 years and 71.4% were female. Mean disease duration was 1.2 ± 0.8 years. Median EDSS score was 1.0 (IQR 0, 2.0). One hundred thirty patients (68.8%) were working for pay or self-employed. Fifty-three patients (40.8%) reported absence from work in the past 3 months with an average of 14.3 absent workdays. Their health problems resulted in the loss of 3.4% of their actual work time in the past 7 days. Thirty patients got help (11.8 h) with their unpaid work activities in the past 7 days. Absenteeism was significantly correlated with anxiety and depression (rho=0.298 and 0.291, p<0.001), fatigue (rho=0.214, p = 0.014), and symptom severity (rho=0.213, p = 0.015). Presenteeism was significantly correlated with fatigue (rho=0.375, p<0.001), symptom severity (rho=0.373, p<0.001), depression (rho=0.263, p = 0.008), and disability (rho=0.215, p = 0.031). CONCLUSIONS Productivity loss even in a RRMS population with short disease duration stresses the need for more efficient treatment control of disease activity from earlier stages.
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Affiliation(s)
| | | | - Mónica Borges
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Javier Sotoca
- Department of Neurology, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Ana Alonso
- Department of Neurology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Ana B Caminero
- Department of Neurology, Complejo Asistencial de Ávila, Ávila, Spain
| | - Laura Borrega
- Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | | | | | - Carmen Calles
- Department of Neurology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Luis Brieva
- Department of Neurology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Maria R Blasco
- Department of Neurology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - María Del Campo-Amigo
- Department of Neurology, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Laura Navarro-Cantó
- Department of Neurology, Hospital General Universitario de Elche, Elche, Spain
| | - Eduardo Agüera
- Department of Neurology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Moisés Garcés
- Department of Neurology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Olga Carmona
- Department of Neurology, Fundació Salut Empordà, Figueres, Spain
| | | | - Lucía Forero
- Department of Neurology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Mariona Hervás
- Department of Neurology, Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
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Maurino J, Martínez-Ginés ML, García-Domínguez JM, Solar MD, Carcelén-Gadea M, Ares-Luque A, Ballabriga J, Navarro-Cantó L, Medrano N, Honan CA. Workplace difficulties, health-related quality of life, and perception of stigma from the perspective of patients with Multiple Sclerosis. Mult Scler Relat Disord 2020; 41:102046. [PMID: 32179482 DOI: 10.1016/j.msard.2020.102046] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/26/2020] [Accepted: 03/06/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION In Multiple Sclerosis (MS), withdrawal from employment is a critical problem. This study explores relationships between disease characteristics, work difficulties, health-related quality of life, depression, and stigma and how these factors affect employment status. METHODS A multicenter, non-interventional, cross-sectional study was conducted in adults with relapsing-remitting MS (RRMS) and primary progressive MS (PPMS). Patient-reported questionnaires included: 23-item Multiple Sclerosis Work Difficulties Questionnaire, 29-item Multiple Sclerosis Impact Scale, Stigma Scale for Chronic Illness, and Beck Depression Inventory-Fast Screen. RESULTS A total of 199 individuals (mean age = 43.9 ± 10.5 years, 60.8% female, 86.4% with RRMS) participated in the study. Mean time from diagnosis was 9.6 ± 7.2 years and median Expanded Disability Status Scale score was 2.0 (interquartile range: 1.0-3.5). Employment rate was 47.2% (n = 94). Mean physical and psychological MSIS-29 impact sub-scores were 40.38 ± 17.1 and 20.24 ± 7.8, respectively. Forty patients (19.9%) had at least one SSCI-8 item with a score of 4 or 5, suggesting the presence of stigma often or always. Eighty-one patients (40.7%) were depressed and 25 (12.6%) had moderate-to-severe depression. Work difficulties were higher in those with worse functional status, a diagnosis of PPMS, and lower educational levels. Employed participants had lower perceptions of stigma and depressive symptoms than those not employed. Higher perceptions of stigma were also strongly linked to higher physical and psychological impact on health-related quality of life and greater work difficulties. Depressive symptoms were also strongly related to work-related problems. CONCLUSIONS Work difficulties, stigma and poor quality of life are common in MS patients, even in a population with low physical disability. Evaluation of these dimensions in clinical practice would allow the development of targeted rehabilitation and specific work plans for MS employers.
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Affiliation(s)
| | | | | | - María D Solar
- Department of Neurology, Hospital Universitario de Cabueñes, Gijón, Spain
| | - María Carcelén-Gadea
- Department of Neurology, Hospital General Universitario de Valencia, Valencia, Spain
| | - Adrián Ares-Luque
- Department of Neurology, Complejo Asistencial Universitario de León, Spain
| | - Jordi Ballabriga
- Department of Neurology, Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain
| | - Laura Navarro-Cantó
- Department of Neurology, Hospital General Universitario de Elche, Elche, Spain
| | | | - Cynthia A Honan
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
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Terzaghi MA, Ruiz C, Martínez-López I, Pérez-Encinas M, Bakdache F, Maurino J, Saposnik G. Factors associated with therapeutic inertia among pharmacists caring for people with multiple sclerosis. Mult Scler Relat Disord 2019; 39:101887. [PMID: 31846865 DOI: 10.1016/j.msard.2019.101887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/01/2019] [Accepted: 12/07/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Pharmacists play a critical role on therapeutic decisions in multiple sclerosis (MS) care. Therapeutic inertia (TI) is defined as the lack of treatment initiation or escalation when there was evidence of clinical and radiological disease activity. The aim of this study was to assess factors associated with TI among pharmacists involved in MS care. METHODS A multicenter, non-interventional, cross-sectional study involving hospital pharmacists in Spain was conducted. Participants answered questions regarding their standard practice, risk preferences, and management of nine simulated MS case-scenarios. We created a score defined as the number of case-scenarios that fit the TI criteria over the total number of presented cases (score range from 0-6). Similarly, an optimal treatment score (OTS) was created to determine the degree of appropriate pharmacological decisions (ranging from 0-lowest to 9-highest). Candidate predictors of TI included demographic data, practice setting, years of practice, MS expertise, number of MS patients managed at hospital/year, participation in MS clinical trials, and participants' risk preferences. RESULTS Overall, 65 pharmacists initiated and completed the study (response rate: 45.5%). The mean age was 43.5 ± 7.8 years and 67.1% were female. Forty-two (64.6%) participants had specialization in MS management. Overall, the mean TI score was 3.4 ± 1.1. Of 390 individual responses, 224 (57.4%) met the TI criteria. All participants failed to recommend treatment escalation in at least one of the six case-scenarios. The mean OTS was 4.1 ± 1.4. Of 585 individual responses, 264 (45.1%) met the optimal choice criteria. Only 40% of participants (23/65) made five or more optimal treatment choices. Lower experience in dispensing MS drugs and lack of specialization in MS were the most common factors associated with TI and optimal management. The multivariable analysis revealed that more years of experience (p = 0.03), being a co-author of a peer-reviewed publication (p = 0.03), and specialization in MS (p = 0.017) were associated with lower TI scores (adjusted R2 = 0.23). CONCLUSION Therapeutic inertia was observed in all pharmacist participants, affecting over fifty percent of MS treatment choices. Continuing education and specialization in MS may facilitate therapeutic decisions in MS care.
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Affiliation(s)
- Maria A Terzaghi
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Canada
| | - Cedrik Ruiz
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Canada
| | - Iciar Martínez-López
- Department of Pharmacy, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | | | - Fabien Bakdache
- Medical Affairs, Neuroscience, Hoffmann-La Roche Limited, Mississauga, Canada
| | | | - Gustavo Saposnik
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Canada; Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Switzerland.
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García-Domínguez JM, Maurino J, Martínez-Ginés ML, Carmona O, Caminero AB, Medrano N, Ruíz-Beato E. Economic burden of multiple sclerosis in a population with low physical disability. BMC Public Health 2019; 19:609. [PMID: 31109317 PMCID: PMC6528334 DOI: 10.1186/s12889-019-6907-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 04/29/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In multiple sclerosis (MS), half of affected people are unemployed within 10 years of diagnosis. The aim of this study was to assess the economic impact of MS in adult subjects with relapsing-remitting MS (RRMS) and primary progressive MS (PPMS). METHODS A multicenter, non-interventional, cross-sectional study was conducted. The Expanded Disability Status Scale (EDSS) and the 23-item Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ-23) were used to assess disability and work performance, respectively. Only indirect costs were considered using the human capital method, including work costs. Professional support costs and informal caregivers' costs were also estimated. RESULTS A total of 199 subjects were studied (mean age: 43.9 ± 10.5 years, 60.8% female, 86.4% with RRMS). Median EDSS score was 2.0 (interquartile range: 1.0-3.5) and median MSWDQ-23 total score was 31.5 (15.2, 50.0). The number of employed subjects decreased after MS diagnosis from 70.6 to 47.2%, and the number of retired people increased (23.6%). Mean age of retirement was 43.6 ± 10.5 years. Ten percent of the population had sick leaves (absenteeism was seen in 90.9% of the student population and 30.9% of the employed population). Professional support in their daily life activities was needed in 28.1% of subjects. Costs for sick leave, work absenteeism, premature retirement and premature work disability/pensioner were €416.6 ± 2030.2, €763.4 ± 3161.8, €5810.1 ± 13,159.0 and €1816.8 ± 9630.7, respectively. Costs for professional support and informal caregiving activities were €1026.93 ± 4622.0 and €1328.72, respectively. CONCLUSIONS MS is responsible for a substantial economic burden due to indirect and informal care costs, even in a population with low physical disability.
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Affiliation(s)
| | - Jorge Maurino
- Medical Department, Roche Farma, Ribera del Loira, 50, 28042, Madrid, Spain.
| | | | - Olga Carmona
- Department of Neurology, Hospital de Figueres, Figueres, Spain
| | - Ana B Caminero
- Department of Neurology, Hospital Nuestra Señora de Sonsoles, Complejo Asistencial de Ávila, Ávila, Spain
| | - Nicolás Medrano
- Medical Department, Roche Farma, Ribera del Loira, 50, 28042, Madrid, Spain
| | - Elena Ruíz-Beato
- Health Economics and Outcomes Research Unit, Roche Farma, Madrid, Spain
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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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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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