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Alonso-Magdalena L, Carmona I Codina O, Zia E, Sundström P, Pessah-Rasmussen H. Prevalence and disease disability in immigrants with multiple sclerosis in Malmö, southern Sweden. Clin Neurol Neurosurg 2024; 240:108255. [PMID: 38552363 DOI: 10.1016/j.clineuro.2024.108255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common chronic demyelinating disease of the central nervous system and the major non-traumatic cause of permanent disability in young adults. Several migration studies have been performed over the years suggesting a pattern of higher disease disability in certain ethnic groups. To our knowledge, differences in disease progression in immigrants have not been studied in Sweden before. Thus, the aims of our study were to estimate the prevalence of multiple sclerosis among first-generation immigrants in the City of Malmö and to compare differences in disease severity with the native population. METHODS All persons with multiple sclerosis living in Malmö on prevalence day 31 Dec 2010 were included. Cases were classified according to the country of birth into Scandinavians, Western and non-Western. RESULTS The crude prevalence was 100/100,000 (95% CI, 80-124) among first-generation immigrants, 154/100,000 (95% CI, 137-173) among individuals with Scandinavian background, 123/100,000 (95% CI, 94-162) in the Western group and 76/100,000 (95% CI, 53-108) in the non-Western group. The mean Multiple Sclerosis Severity Score (MSSS) value among Scandinavians was 4.2 (SD 3.5), whereas the figures in the immigrant group were 4.6 (SD 3.3) and 5.2 (SD 3.7) among Westerns respectively non-Westerns, which differences were not statistically significant. When adjusting for gender, age at onset and initial disease course, the mean MSSS difference between the non-Western and the Scandinavian individuals was 1.7 (95% CI 0.18-3.3, p = 0.030). There were no differences on time to diagnosis or the time from diagnosis to treatment initiation between the three groups. CONCLUSIONS We found a lower prevalence among Western and non-Western first-generation immigrants compared to the Scandinavian population and a more severe disease in non-Western immigrants than in Scandinavians.
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Affiliation(s)
- Lucía Alonso-Magdalena
- Department of Neurology, Skåne University Hospital and Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Olga Carmona I Codina
- Department of Neurology, Fundacio Salut Emporda, Figueres and Department of Clinical Sciences, Faculty of Medicine, Girona University, Spain
| | - Elisabet Zia
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Peter Sundström
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Hélène Pessah-Rasmussen
- Department of Rehabilitation medicine, Skåne University Hospital and Department of Clinical Sciences, Lund University, Lund, Sweden
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2
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Dahham J, Hiligsmann M, Kremer I, Khoury SJ, Darwish H, Hosseini H, Hallit S, Evers S, Rizk R. Health-related quality of life and utilities among Lebanese patients with Multiple Sclerosis: A cross-sectional study. Mult Scler Relat Disord 2024; 86:105635. [PMID: 38640585 DOI: 10.1016/j.msard.2024.105635] [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: 11/18/2023] [Revised: 01/29/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE This study assessed the Health-Related Quality of Life (HRQoL) and utilities of Multiple Sclerosis (MS) patients in Lebanon using generic and MS-specific QoL instruments, categorized by disease severity, and explored factors associated with HRQoL. METHODS This was a cross-sectional, retrospective HRQoL study collecting data through face-to-face interviews using the EQ-5D-5 L and the Multiple Sclerosis International Quality of Life (MusiQoL) questionnaires. We enrolled Lebanese patients aged ≥18 years, diagnosed with MS for >6 months. Patients were categorized by disease severity using the expanded disability status scale (EDSS) scores: 0-3 (mild MS), 4-6.5 (moderate MS), and 7-9 (severe MS). Bivariate and linear regression analyses were performed to study factors associated with HRQoL. RESULTS A total of 210 patients (mean age: 43.3 years; 65.7 % females) were included. The mean EQ-5D-5 L utility score was 0.74. This score decreased significantly with disease severity (p < 0.001 for the trend): 0.93, 0.60, and 0.32 for mild, moderate, and severe MS, respectively. The mean MusiQoL global index score was 71.33 and was significantly lower for severe MS (58.68), than for moderate (65.23) and mild (77.80), (p < 0.001 for the trend). Higher educational level, lower EDSS scores, and longer disease duration were associated significantly with a higher EQ-5D-5 L utility (R2 = 0.67), while employment, lower EDSS scores, and decrease in cognitive difficulties were associated with better MusiQoL utility (R2 = 0.46). CONCLUSIONS This study reveals a significant and gradual deterioration in HRQoL as MS progresses, resulting in low utility scores for patients with severe MS.
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Affiliation(s)
- Jalal Dahham
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon.
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Ingrid Kremer
- Project Manager Value-Based Health Care at Maastro, Maastricht, the Netherlands
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon; Abu-Haidar Neuroscience Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hala Darwish
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon; Hariri School of Nursing, American University of Beirut, Beirut, Lebanon; University of Michigan, Ann Arbor, Michigan, United States
| | - Hassan Hosseini
- Service de Neurologie, Hôpital Henri Mondor, Créteil, France
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O box 446, Jounieh, Lebanon; Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Silvia Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Centre for Economic Evaluations and Machine Learning, Trimbos Institute, Utrecht, the Netherlands
| | - Rana Rizk
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon; Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Byblos, Lebanon
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De Keersmaecker AV, Van Doninck E, Popescu V, Willem L, Cambron M, Laureys G, D’ Haeseleer M, Bjerke M, Roelant E, Lemmerling M, D’hooghe MB, Derdelinckx J, Reynders T, Willekens B. A metformin add-on clinical study in multiple sclerosis to evaluate brain remyelination and neurodegeneration (MACSiMiSE-BRAIN): study protocol for a multi-center randomized placebo controlled clinical trial. Front Immunol 2024; 15:1362629. [PMID: 38680485 PMCID: PMC11046490 DOI: 10.3389/fimmu.2024.1362629] [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: 12/28/2023] [Accepted: 02/05/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Despite advances in immunomodulatory treatments of multiple sclerosis (MS), patients with non-active progressive multiple sclerosis (PMS) continue to face a significant unmet need. Demyelination, smoldering inflammation and neurodegeneration are important drivers of disability progression that are insufficiently targeted by current treatment approaches. Promising preclinical data support repurposing of metformin for treatment of PMS. The objective of this clinical trial is to evaluate whether metformin, as add-on treatment, is superior to placebo in delaying disease progression in patients with non-active PMS. Methods and analysis MACSiMiSE-BRAIN is a multi-center two-arm, 1:1 randomized, triple-blind, placebo-controlled clinical trial, conducted at five sites in Belgium. Enrollment of 120 patients with non-active PMS is planned. Each participant will undergo a screening visit with assessment of baseline magnetic resonance imaging (MRI), clinical tests, questionnaires, and a safety laboratory assessment. Following randomization, participants will be assigned to either the treatment (metformin) or placebo group. Subsequently, they will undergo a 96-week follow-up period. The primary outcome is change in walking speed, as measured by the Timed 25-Foot Walk Test, from baseline to 96 weeks. Secondary outcome measures include change in neurological disability (Expanded Disability Status Score), information processing speed (Symbol Digit Modalities Test) and hand function (9-Hole Peg test). Annual brain MRI will be performed to assess evolution in brain volumetry and diffusion metrics. As patients may not progress in all domains, a composite outcome, the Overall Disability Response Score will be additionally evaluated as an exploratory outcome. Other exploratory outcomes will consist of paramagnetic rim lesions, the 2-minute walking test and health economic analyses as well as both patient- and caregiver-reported outcomes like the EQ-5D-5L, the Multiple Sclerosis Impact Scale and the Caregiver Strain Index. Ethics and dissemination Clinical trial authorization from regulatory agencies [Ethical Committee and Federal Agency for Medicines and Health Products (FAMHP)] was obtained after submission to the centralized European Clinical Trial Information System. The results of this clinical trial will be disseminated at scientific conferences, in peer-reviewed publications, to patient associations and the general public. Trial registration ClinicalTrials.gov Identifier: NCT05893225, EUCT number: 2023-503190-38-00.
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Affiliation(s)
- Anna-Victoria De Keersmaecker
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
- Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
| | - Eline Van Doninck
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Center of Health Economic Research and Modelling Infectious Diseases, University of Antwerp, Wilrijk, Belgium
| | - Veronica Popescu
- Immunology and Infection, University of Hasselt, Diepenbeek, Belgium
- Biomedical Research Institute, University of Hasselt, Diepenbeek, Belgium
- Department of Neurology, Noorderhart Maria Hospital, Pelt, Belgium
- University Multiple Sclerosis Centre, University of Hasselt, Hasselt, Belgium
| | - Lander Willem
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Center of Health Economic Research and Modelling Infectious Diseases, University of Antwerp, Wilrijk, Belgium
| | - Melissa Cambron
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
- Department of Neurology, Algemeen Ziekenhuis Sint Jan, Bruges, Belgium
| | - Guy Laureys
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
- Department of Neurology, University Hospital Ghent, Ghent, Belgium
| | - Miguel D’ Haeseleer
- Department of Neurology, University Hospital Brussels, Brussels, Belgium
- Department of Neurology, National Multiple Sclerosis Center, Melsbroek, Belgium
- Department Neuroprotection and Neuromodulation, Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maria Bjerke
- Department Neuroprotection and Neuromodulation, Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Neurochemistry Laboratory, Department of Clinical Biology, Brussels, University Hospital Brussels, Brussels, Belgium
- Department of Biomedical Sciences, University of Antwerp, Wilrijk, Belgium
| | - Ella Roelant
- Clinical Trial Center, Antwerp University Hospital, Edegem, Belgium
| | - Marc Lemmerling
- Department of Radiology, Antwerp University Hospital, Edegem, Wilrijk, Belgium
| | - Marie Beatrice D’hooghe
- Department of Neurology, University Hospital Brussels, Brussels, Belgium
- Department of Neurology, National Multiple Sclerosis Center, Melsbroek, Belgium
- Department Neuroprotection and Neuromodulation, Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Judith Derdelinckx
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
- Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Tatjana Reynders
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
- Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
| | - Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
- Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
- Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Braune S, Bluemich S, Bruns C, Dirks P, Hoffmann J, Heer Y, Rouzic EML, Bergmann A. The natural history of primary progressive multiple sclerosis: insights from the German NeuroTransData registry. BMC Neurol 2023; 23:258. [PMID: 37407914 DOI: 10.1186/s12883-023-03273-9] [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: 02/24/2023] [Accepted: 06/02/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Primary progressive multiple sclerosis (PPMS) is characterised by gradual worsening of disability from symptom onset. Knowledge about the natural course of PPMS remains limited. METHODS PPMS patients from the German NeuroTransData (NTD) MS registry with data from 56 outpatient practices were employed for retrospective cross-sectional and longitudinal analyses. The cross-sectional analysis included a contemporary PPMS cohort with a documented visit within the last 2 years before index date (1 Jan 2021). The longitudinal analysis included a disease modifying therapy (DMT)-naïve population and focused on the evolution of expanded disability status scale (EDSS) from the first available assessment at or after diagnosis within the NTD registry to index date. Outcome measures were estimated median time from first EDSS assessment to first 24-week confirmed EDSS ≥ 4 and ≥ 7. Besides EDSS change, the proportion of patients on disability pension were described over time. RESULTS The cross-sectional analysis included 481 PPMS patients (59.9% female, mean [standard deviation, SD] age 60.5 [11.5] years, mean [SD] EDSS 4.9 [2.1]). Estimated median time from first EDSS assessment after diagnosis to reach 24-week confirmed EDSS ≥ 4 for DMT-naïve patients was 6.9 years. Median time to EDSS ≥ 7 was 9.7 years for 25% of the population. Over a decade mean (SD) EDSS scores increased from 4.6 (2.1) to 5.7 (2.0); the proportion of patients on disability pension increased from 18.9% to 33.3%. CONCLUSIONS This study provides first insights into the German NTD real-world cohort of PPMS patients. Findings confirm the steadily deteriorating course of PPMS accompanied by increasingly limited quality of life.
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Affiliation(s)
| | | | | | - Petra Dirks
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Yanic Heer
- PricewaterhouseCoopers (PwC), Zurich, Switzerland
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Ponzio M, Monti MC, Mallucci G, Borrelli P, Fusco S, Tacchino A, Brichetto G, Tronconi L, Montomoli C, Bergamaschi R. The economic impact of comorbidity in multiple sclerosis. Neurol Sci 2023; 44:999-1008. [PMID: 36441342 PMCID: PMC9925507 DOI: 10.1007/s10072-022-06517-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Comorbid conditions are common in people with multiple sclerosis (pwMS). They can delay diagnosis and negatively impact the disease course, progression of disability, therapeutic management, and adherence to treatment. OBJECTIVE To quantify the economic impact of comorbidity in multiple sclerosis (MS), based on cost-of-illness estimates made using a bottom-up approach. METHODS A retrospective study was carried out in two northern Italian areas. The socio-demographic and clinical information, including comorbidities data, were collected through ad hoc anonymous self-assessment questionnaire while disease costs (direct and indirect costs of disease and loss of productivity) were estimated using a bottom-up approach. Costs were compared between pwMS with and without comorbidity. Adjusted incremental costs associated with comorbidity were reported using generalized linear models with log-link and gamma distributions or two-part models. RESULTS 51.0% of pwMS had at least one comorbid condition. Hypertension (21.0%), depression (15.7%), and anxiety (11.7%) were the most prevalent. PwMS with comorbidity were more likely to use healthcare resources, such as hospitalizations (OR = 1.21, p < 0.001), tests (OR = 1.59, p < 0.001), and symptomatic drugs and supplements (OR = 1.89, p = 0.012), and to incur non-healthcare costs related to investment (OR = 1.32, p < 0.001), transportation (OR = 1.33, p < 0.001), services (OR = 1.33, p < 0.001), and informal care (OR = 1.43, p = 0.16). Finally, they experienced greater productivity losses (OR = 1.34, p < 0.001) than pwMS without comorbidity. The adjusted incremental annual cost per patient due to comorbidity was €3,106.9 (13% of the overall costs) with MS disability found to exponentially affect annual costs. CONCLUSION Comorbidity has health, social, and economic consequences for pwMS.
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Affiliation(s)
- Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy.
| | - Maria Cristina Monti
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Giulia Mallucci
- Multiple Sclerosis Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Paola Borrelli
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University ''G. d'Annunzio'' Chieti-Pescara, Chieti, Italy
| | - Sara Fusco
- Multiple Sclerosis Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Livio Tronconi
- Legal Medicine Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Public Health, Experimental and Forensic Medicine, Forensic Science Unit, University of Pavia, Pavia, Italy
| | - Cristina Montomoli
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
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Dykukha I, Essner U, Schreiber H, Raithel LM, Penner IK. Effects of Sativex Ⓡ on cognitive function in patients with multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2022; 68:104173. [PMID: 36174323 DOI: 10.1016/j.msard.2022.104173] [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: 01/05/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cognitive impairment is a common manifestation of multiple sclerosis (MS). OBJECTIVE To assess by systematic review and meta-analysis available evidence regarding the impact of nabiximols oromucosal spray on cognition in patients with MS. METHODS A systematic literature search of clinical studies (all types, any comparator) that measured cognitive function in patients with MS spasticity treated with nabiximols. Meta-analysis for cognitive endpoints was not possible due to heterogenous measurement instruments and outcomes. Meta-analysis was performed for adverse events (AEs) of special interest (cognition disorders) reported in randomized controlled trials (RCTs) of nabiximols versus placebo in patients with MS (with or without spasticity). Certainty of evidence and risk of bias were assessed. RESULTS Seven clinical studies (three RCTs) directly assessing cognitive function were included in the qualitative analysis. There was no consistent evidence to suggest that nabiximols causes cognitive impairment as assessed by a range of specific psychometric instruments across cognitive domains. Thirteen double-blind, placebo-controlled RCTs (nabiximols, n = 964; placebo, n = 904) were included in the meta-analysis of cognitive AEs. Most cognitive AEs (30 of 32 events, 93.8%) reported with nabiximols in MS patients occurred with not in-label use, i.e., dosage >12 sprays per day and/or not administered primarily for treatment of spasticity. CONCLUSIONS Within the limitations of the review, we can conclude that no detrimental effects of nabiximols on cognitive function were observed in patients with MS spasticity during up to 12 months follow-up and that cognitive AEs were rare and occurred only when nabiximols was not used according to its approved label.
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Affiliation(s)
- Igor Dykukha
- Medical Affairs, Almirall Hermal GmbH, Reinbek, Germany
| | - Ute Essner
- O. Meany Consultancy GmbH, Hamburg, Germany
| | - Herbert Schreiber
- Neurological Practice Center, Neuropoint Academy, NTD & Neurosys, Ulm, Germany
| | - Lina Marie Raithel
- COGITO Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany
| | - Iris-Katharina Penner
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
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Tarasiuk J, Kapica-Topczewska K, Czarnowska A, Chorąży M, Kochanowicz J, Kułakowska A. Co-occurrence of Fatigue and Depression in People With Multiple Sclerosis: A Mini-Review. Front Neurol 2022; 12:817256. [PMID: 35242093 PMCID: PMC8886154 DOI: 10.3389/fneur.2021.817256] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/20/2021] [Indexed: 12/11/2022] Open
Abstract
Fatigue and depression are common conditions diagnosed in people with multiple sclerosis (MS). Fatigue defined as subjective lack of physical and/or mental energy is present in 35–97% of people with MS, who classify it as one of the most serious symptoms interfering with daily activities and influencing the quality of life. Depression is diagnosed in about 50% of people with MS. Since fatigue and depression frequently coexists, it may be quite hard to differentiate them. Primary fatigue and primary depression in MS are caused by inflammatory, oxidative/nitrosative, and neurodegenerative processes leading to demyelination, axonal damage, and brain atrophy. In people with MS and comorbid fatigue and/or depression there is reported increased serum and cerebrospinal fluid concentration of inflammatory mediators such as tumor necrosis factor, interleukins (IL-1a, IL-1b, IL-6), interferon γ and neopterin. Moreover, the brain atrophy of prefrontal, frontal, parietotemporal regions, thalamus, and basal ganglia was observed in people with MS with fatigue and/or depression. The secondary fatigue and secondary depression in people with MS may be caused by emotional factors, sleep disorders, pain, the coexistence of other diseases, and the use of medications. In some studies, the use of disease-modifying therapies positively influenced fatigue, probably by reducing the inflammatory response, which proves that fatigue and depression are closely related to immunological factors. In this mini-review, the pathogenesis, methods of evaluation and differentiation, and possible therapies for fatigue and depression in MS are discussed.
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Affiliation(s)
- Joanna Tarasiuk
- Department of Neurology, Medical University of Bialystok, Białystok, Poland
| | | | - Agata Czarnowska
- Department of Neurology, Medical University of Bialystok, Białystok, Poland
| | - Monika Chorąży
- Department of Neurology, Medical University of Bialystok, Białystok, Poland
| | - Jan Kochanowicz
- Department of Neurology, Medical University of Bialystok, Białystok, Poland
| | - Alina Kułakowska
- Department of Neurology, Medical University of Bialystok, Białystok, Poland
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8
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Dahham J, Rizk R, Hiligsmann M, Daccache C, Khoury SJ, Darwish H, Evers S, Kremer I. The Economic and societal burden of multiple sclerosis on lebanese society: a cost-of-illness and quality of life study protocol. Expert Rev Pharmacoecon Outcomes Res 2021; 22:869-876. [PMID: 34826264 DOI: 10.1080/14737167.2022.2008242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This protocol describes the estimation of the societal costs and quality-of-life (QOL) burden of multiple sclerosis (MS) in Lebanon. This cross-sectional, prevalence-based burden-of-illness study was carried out in a premier MS center in Lebanon. We enrolled Lebanese patients aged 18 years and older who had been diagnosed with MS more than 6 months. The study uses a bottom-up approach to estimate the cost-of-illness (COI) and QOL using a retrospective face-to-face interview questionnaire. This resource utilization questionnaire was adapted to the Lebanese context by clinical and health economics experts. The methodologies used to estimate the consumption of healthcare resources, informal care, and productivity losses are well-defined and aligned with the Lebanese healthcare system. Costs are presented overall and by MS severity levels. QOL is measured using the EuroQOL (EQ-5D-5 L) and Multiple Sclerosis International Quality of Life (MusiQoL) instrument. This protocol pioneers in informing the design of future COI and QOL studies in low - and middle-income countries (LMICs), as the methods used could be applied in similar LMICs. Furthermore, we provide recommendations and discuss the challenges of conducting a high-quality burden-of-illness study in LMICs and the steps taken to meet them, using the case of Lebanon.
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Affiliation(s)
- Jalal Dahham
- Department of Health Services Research, Care and Public Health Research Institute (Caphri), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Rana Rizk
- Institut National de Santé Publique, D'épidémiologie Clinique Et de Toxicologie (Inspect-lb), Beirut, Lebanon
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (Caphri), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Caroline Daccache
- Department of Health Services Research, Care and Public Health Research Institute (Caphri), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, Department of Neurology, Faculty of medicine American University of Beirut Medical Center, Beirut, Lebanon
| | - Hala Darwish
- Hariri School of Nursing, American University of Beirut, Lebanon Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Lebanon
| | - Silvia Evers
- Department of Health Services Research, Care and Public Health Research Institute (Caphri), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Centre for Economic Evaluations and Machine Learning, Trimbos Institute, Utrecht, The Netherlands
| | - Ingrid Kremer
- Department of Health Services Research, Care and Public Health Research Institute (Caphri), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Schriefer D, Haase R, Ness NH, Ziemssen T. Cost of illness in multiple sclerosis by disease characteristics - A review of reviews. Expert Rev Pharmacoecon Outcomes Res 2021; 22:177-195. [PMID: 34582300 DOI: 10.1080/14737167.2022.1987218] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: In light of the increasing number of economic burden studies and heterogeneity in methodology and reporting standards, there is a need for robust evidence synthesis on an umbrella review level.Areas covered: We performed the first review of reviews of cost-of-illness studies in multiple sclerosis. Focusing on disaggregated costs by disease characteristics (disability level, relapse, disease course), we also characterized the underlying methodological evidence base of individual (primary) studies.Expert Commentary: We identified 17 reviews encompassing 111 unique primary studies, and a high degree of overlap across reviews. Costs were substantial, rising with disability level, relapse episodes, and disease progression. Disability was the key cost driver. Compared to mild disability, total costs for moderate disability were 1.4-2.3-fold higher and 1.8-2.9-fold higher for severe disability. With escalating disability, the share of costs outside the health system (indirect costs, informal care) increasingly outweighed the share of direct medical costs. Of all 111 primary studies, 72% gathered resource use/loss data by patient self-report. Associated costs were mostly reported by disability level (75%), followed by relapse (48%) and disease course (21%). In conclusion, although heterogeneity can make in-depth comparisons of costs across studies impossible, important patterns are broadly apparent.
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Affiliation(s)
- Dirk Schriefer
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Rocco Haase
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
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Lechner-Scott J, Reeves P, Ribbons K, Saugbjerg B, Lea R. Do people with multiple sclerosis receive appropriate support from the National Disability Insurance Scheme matching their level of disability? A description of disease 'burden and societal cost in people with multiple sclerosis in Australia. AUST HEALTH REV 2021; 45:745-752. [PMID: 34543604 DOI: 10.1071/ah21056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/24/2021] [Indexed: 11/23/2022]
Abstract
ObjectiveThis study is the first to assess if the National Disability Insurance Scheme (NDIS) package allocated to people with multiple sclerosis (pwMS) is correlated with the disability level measured by standardised neurological assessment.MethodsWe aimed to recruit 10 pwMS per expanded disability status score (EDSS) step, including EDSS 0 (no disability) up to 9 (bedridden), and requested information about their NDIS application. Value of their packages was compared with mobility, cognition and psychological impact.ResultsOut of 186 pwMS, only 49% of all patients had an NDIS package approved. The mean values of the annual allowance were AU$30318 for patients with mild disability, AU$38361 for moderate disability and AU$115113 for severe disability. There was a striking variability in packages approved, but restricted mobility seems to be the driving factor. Rejection rates were <20% in patients with mild and moderate disability and none in those with severe disability. The package value correlated with EDSS steps, cognitive impairment and physical impact, but not psychological impact.ConclusionsThis is the first study to assess if NDIS packages correlate with internationally accepted disability scales. The NDIS support was correlated with disability measured by EDSS steps and cognition, but not psychological impact of the disease.What is known about the topic?There are over 25000 Australians living with multiple sclerosis, which is one of the most common neurological diseases leading to disability in early age. The National Disability Insurance Scheme has been introduced since 2013 to particularly assist young disabled Australians to participate in the community. Whether the approved package correlates with internationally accepted disability scores has not yet been assessed.What does this paper add?This study is the first to correlate disability, as assessed by the Expanded Disability Severity Scale (EDSS), with the approved package value.What are the implications for practitioners?Multiple sclerosis is a very variable disease affecting quality of life not only due to impairment of mobility, but also cognition and mental health. Although the NDIS package value was correlated with an EDSS and cognition, the psychological impact of the disease is often neglected.
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Affiliation(s)
- Jeannette Lechner-Scott
- John Hunter Hospital, Department of Neurology, New Lambton Heights, NSW 2305, Australia; and Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW 2305, Australia. ; ; ; ; and Corresponding author.
| | - Penny Reeves
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW 2305, Australia. ; ; ;
| | - Karen Ribbons
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW 2305, Australia. ; ; ;
| | - Bente Saugbjerg
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW 2305, Australia. ; ; ;
| | - Rodney Lea
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW 2305, Australia. ; ; ; ; and Queensland University of Technology, Brisbane, Qld 4000, Australia
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11
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Oppe M, Ortín-Sulbarán D, Vila Silván C, Estévez-Carrillo A, Ramos-Goñi JM. Cost-effectiveness of adding Sativex® spray to spasticity care in Belgium: using bootstrapping instead of Monte Carlo simulation for probabilistic sensitivity analyses. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:711-721. [PMID: 33880663 PMCID: PMC8214588 DOI: 10.1007/s10198-021-01285-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Uncertainty in model-based cost-utility analyses is commonly assessed in a probabilistic sensitivity analysis. Model parameters are implemented as distributions and values are sampled from these distributions in a Monte Carlo simulation. Bootstrapping is an alternative method that requires fewer assumptions and incorporates correlations between model parameters. METHODS A Markov model-based cost-utility analysis comparing oromucosal spray containing delta-9-tetrahidrocannabinol + cannabidiol (Sativex®, nabiximols) plus standard care versus standard spasticity care alone in the management of multiple sclerosis spasticity was performed over a 5-year time horizon from the Belgian healthcare payer perspective. The probabilistic sensitivity analysis was implemented using a bootstrap approach to ensure that the correlations present in the source clinical trial data were incorporated in the uncertainty estimates. RESULTS Adding Sativex® spray to standard care was found to dominate standard spasticity care alone, with cost savings of €6,068 and a quality-adjusted life year gain of 0.145 per patient over the 5-year analysis. The probability of dominance increased from 29% in the first year to 94% in the fifth year, with the probability of QALY gains in excess of 99% for all years considered. CONCLUSIONS Adding Sativex® spray to spasticity care was found to dominate standard spasticity care alone in the Belgian healthcare setting. This study showed the use of bootstrapping techniques in a Markov model probabilistic sensitivity analysis instead of Monte Carlo simulations. Bootstrapping avoided the need to make distributional assumptions and allowed the incorporation of correlating structures present in the original clinical trial data in the uncertainty assessment.
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Affiliation(s)
- Mark Oppe
- Axentiva Solutions, S.L., C/Muntaner, 200 4º 5ª, 08036, Barcelona, Spain.
| | | | | | | | - Juan M Ramos-Goñi
- Axentiva Solutions, S.L., C/Muntaner, 200 4º 5ª, 08036, Barcelona, Spain
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Karamini A, Bakopoulou A, Andreadis D, Gkiouras K, Kritis A. Therapeutic Potential of Mesenchymal Stromal Stem Cells in Rheumatoid Arthritis: a Systematic Review of In Vivo Studies. Stem Cell Rev Rep 2021; 16:276-287. [PMID: 31950339 DOI: 10.1007/s12015-020-09954-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Standard treatment options for rheumatoid arthritis (RA) often fail to deliver a long-term therapeutic outcome and in many cases cause intractable adverse events leading to treatment discontinuation or readjustment. Treatment with mesenchymal stem cells (MSCs) has been recently studied in RA due to its immunomodulatory and anti-inflammatory capacities. Thus, this study aims at systematically search and review the literature for randomized or non-randomized clinical trials comparing interventions of MSCs with placebo in RA patients. Electronic searches were conducted on PubMed, SCOPUS, Cochrane-CENTRAL, registries of clinical trials and grey literature. Selected studies were estimated for risk of bias with the Cochrane RoB tool 2 or the ROBINS-I tool. Four trials met the eligibility criteria and entered the review process. Identified MSCs treatments varied from allogeneic to autologous or umbilical cord-derived cells. Enrolled patients had an active RA and had poor responses to previous standard medications. In general, the safety evaluation revealed that treatment with MSCs was safe and well tolerated. Regarding the efficacy measurements, modest improvements were found in RA symptoms and RA-related indices. Significant decreases were found in inflammatory molecules such as C-reactive protein, tumor necrosis factor alpha and interleukin 6. However, clinical response criteria related to RA were achieved by a low-to-moderate percentage of patients. In conclusion, treatment of RA with MSCs appears to have a short-term therapeutic effect. Better-designed randomized trials with sufficient follow-up periods are needed so that the long-term safety and efficacy interventions with MSCs would be elucidated.
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Affiliation(s)
- Alexia Karamini
- Department of Physiology and Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (A.U.Th), Thessaloniki, Greece.
| | - Athina Bakopoulou
- cGMP Regenerative Medicine Facility, Department of Physiology and Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (A.U.Th), Thessaloniki, Greece
- Department of Prosthodontics, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki (A.U.Th), GR-54124, Thessaloniki, Greece
| | - Dimitrios Andreadis
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki (A.U.Th), Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Department of Physiology and Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (A.U.Th), Thessaloniki, Greece
| | - Aristeidis Kritis
- Department of Physiology and Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (A.U.Th), Thessaloniki, Greece.
- cGMP Regenerative Medicine Facility, Department of Physiology and Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (A.U.Th), Thessaloniki, Greece.
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Carnero Contentti E, López PA, Criniti J, Pettinicchi JP, Tavolini D, Mainella C, Tizio S, Tkachuk V, Silva B, Caride A, Rojas JI, Alonso R. Use of cannabis in patients with multiple sclerosis from Argentina. Mult Scler Relat Disord 2021; 51:102932. [PMID: 33848817 DOI: 10.1016/j.msard.2021.102932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of cannabis to treat some symptoms of neurological diseases, including multiple sclerosis (MS), has increased worldwide. We aimed to assess the use of cannabis in patients with MS (PwMS) from Argentina, its reasons and patients' perceptions on the management of MS symptoms. Additionally, we assessed their association with socio-demographic and clinical aspects. METHODS A cross-sectional online survey that included 281 PwMS from Argentina was conducted. Screening instruments: Demographics and clinical data, health-related QoL (MS Impact Scale-29), Fatigue Severity Scale, The Hospital Anxiety and Depression Scale, sleep disorders, physical disability (self-administrated Expanded Disability Status Scale) and medical or recreational cannabis use were evaluated. A logistic regression model was carried out. RESULTS Current users (cannabis was used within the past year) was reported in 34.2% and former users (had tried cannabis but not used it within the past year) in 22.7%. Daily cannabis use was reported in 31.3% (current + former users) of the studied cohort, 41.9% started their use after MS diagnosis and 54.3% of them had never discussed about cannabis use with their neurologist. Recreational use was reported in 47.5%. Younger (age below 30 years) PwMS (OR = 2.39, p = 0.03), presence of chronic pain (OR = 2.42, p = 0.002) and current alcohol intake (OR = 3.33, p = 0.001) were predictors of current cannabis use in our multivariate model. CONCLUSION A high prevalence of use of cannabis in PwMS from Argentina was observed. Demographic, symptoms and lifestyle factors predict cannabis use. Identifying the presence and severity of these conditions would contribute to a better MS management and treatment.
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Affiliation(s)
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Criniti
- Internal medicine Department, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | | | | | - Santiago Tizio
- Neurology Department, Hospital Italiano y Español de La Plata, Argentina
| | - Verónica Tkachuk
- Neuroimmunology Section, Neurology Department, Hospital de Clínicas "José de San Martín", University of Buenos Aires, Buenos Aires, Argentina
| | - Berenice Silva
- Neurology Department, Hospital J.M. Ramos Mejía, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, Buenos Aires, Argentina
| | - Ricardo Alonso
- Neurology Department, Hospital J.M. Ramos Mejía, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
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Atif M, Alsrhani A, Naz F, Imran M, Imran M, Ullah MI, Alameen AAM, Gondal TA, Raza Q. Targeting Adenosine Receptors in Neurological Diseases. Cell Reprogram 2021; 23:57-72. [PMID: 33861641 DOI: 10.1089/cell.2020.0087] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Adenosine plays a significant role in neurotransmission process by controlling the blood pressure, while adenosine triphosphate (ATP) acts as a neuromodulator and neurotransmitter and by activation of P2 receptors, regulates the contractility of the heart. Adenosine signaling is essential in the process of regeneration by regulating proliferation, differentiation, and apoptosis of stem cells. In this review, we have selected neurological disorders (Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, multiple sclerosis, and epilepsy) with clinical trials using antagonists and epigenetic tools targeting adenosine receptor as a therapeutic approach in the treatment of these disorders. Promising results have been reported from many clinical trials. It has been found that higher expression levels of A2A and P2X7 receptors in neurological disorders further complicate the disease condition. Therefore, modulations of these receptors by using antagonists of these receptors or SAM (S-adenosylmethionine) therapy as an epigenetic tool could be useful in reversing the complications of these disorders. Finally, we suggest that modulation of adenosine receptors in neurological disorders can increase the regenerative phase by increasing the rate of proliferation and differentiation in the damaged tissues.
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Affiliation(s)
- Muhmmad Atif
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
| | - Abdullah Alsrhani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
| | - Farrah Naz
- Department of Microbiology, Government College University, Faisalabad, Pakistan
| | - Muhammad Imran
- University Institute of Diet and Nutritional Sciences, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
| | - Muhammad Imran
- Department of Microbiology, University of Health Sciences, Lahore, Pakistan
| | - Muhammad Ikram Ullah
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
| | - Ayman A M Alameen
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia.,Department of Chemical Pathology, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
| | - Tanweer Aslam Gondal
- School of Exercise and Nutrition, Faculty of Health, Deakin University, Victoria, Australia
| | - Qaisar Raza
- Department of Clinical Nutrition, NUR International University, Lahore, Pakistan
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Liu R, Li Y, Zhou H, Wang H, Liu D, Wang H, Wang Z. OIP5-AS1 facilitates Th17 differentiation and EAE severity by targeting miR-140-5p to regulate RhoA/ROCK2 signaling pathway. Life Sci 2021:119108. [PMID: 33515560 DOI: 10.1016/j.lfs.2021.119108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 01/04/2021] [Accepted: 01/21/2021] [Indexed: 12/18/2022]
Abstract
AIMS Multiple sclerosis (MS) is one of the commonest neurologic disorders globally. LncRNA OIP5-AS1 has been found to be implicated in the etiology of MS. This study was to explore the roles and molecular mechanisms of OIP5-AS1 in the development of MS. MATERIALS AND METHODS RT-qPCR assay was used to measure expressions of OIP5-AS1, miR-140-5p, IL-17A mRNA and RhoA mRNA. CD4+IL-17+ cell proportion was determined by flow cytometry. IL-17A secretion was examined by ELISA assay. Cell inflammatory infiltration and demyelination were assessed by histological analyses. The interaction between miR-140-5p and OIP5-AS1 or RhoA 3'UTR was validated by bioinformatical analysis and luciferase reporter assay. Western blot assay was performed to detect protein expressions of ROCK2 and RhoA. An experimental autoimmune encephalomyelitis (EAE) models was established to explore the role of OIP5-AS1 in MS in vivo. KEY FINDINGS OIP5-AS1 expression was enhanced in MS patients. Also, elevated OIP5-AS1 level was observed during T-helper 17 (Th17) differentiation. Moreover, OIP5-AS1 promoted Th17 differentiation in vitro and contributed to the development of EAE in vivo. Mechanical explorations revealed that OIP5-AS1 targeted miR-140-5p to regulate Th17 differentiation. Moreover, RhoA was a target of miR-140-5p and miR-140-5p inhibited the activation of RhoA/ROCK2 signaling. Also, RhoA upregulation abrogated the inhibitory effects of miR-140-5p on Th17 differentiation. SIGNIFICANCE OIP5-AS1 contributed to EAE development by targeting miR-140-5p/RhoA and activating RhoA/ROCK2 signaling pathway, shedding light on the roles and molecular mechanisms of OIP5-AS1 in the development of MS and providing some candidate targets for the diagnose and treatment of MS.
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Affiliation(s)
- Ruihua Liu
- Department of Neurology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, China.
| | - Yan Li
- Department of Neurology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, China
| | - Haitao Zhou
- Department of Neurology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, China
| | - Hao Wang
- Department of Neurology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, China
| | - Dequan Liu
- Department of Neurology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, China
| | - Huilin Wang
- Department of Neurology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, China
| | - Zhenghua Wang
- Department of Laboratory, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, China
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Gebermariam AD, Tiruneh SA, Ayele AA, Tegegn HG, Ayele BA, Engidaw M. Level of glycemic control and its associated factors among type II diabetic patients in debre tabor general hospital, northwest Ethiopia. Metabol Open 2020; 8:100056. [PMID: 32984805 PMCID: PMC7493082 DOI: 10.1016/j.metop.2020.100056] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/26/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Poor glycemic control is the major risk factor for the development of acute and chronic diabetes complications. There are limited studies on the level of glycemic control and its associated factors among diabetic patients. So, this study aimed to assess the level of glycemic control and its associated factors among type II DM patients in Debre Tabor General Hospital. METHODS An institution based cross sectional study was conducted from November 1-30, 2017. Totally, 413 diabetic patients selected by systematic random sampling. The three months average fasting blood glucose was used to determine glycemic control. Regressions were fitted to identify associated factors. A p-value <0.05 was used to declare statistical significance. RESULT A total of 398 study participants were participated in the study with a response rate of 96.4%. Among 398 type II DM patients, 284 (71.4%) had poor glycemic control. Patient's educational status (able to read and write; AOR = 3.0, 95%CI (1.5, 5.7), (primary education; AOR = 4.5, 95%CI (1.8, 10.9), and (secondary education; AOR = 5.7, 95% CI (2.9, 11.2)))), family history of DM (AOR = 2.3, 95%CI (1.4, 3.9)), duration of DM since diagnosis (AOR = 0.3, 95% CI (0.1, 0.9)), and dietary adherence (AOR = 2.4, 95% CI (1.4, 4.1)) were associated factors to had good glycemic control. CONCLUSION Poor glycemic control was high. Educational status, family history of DM, duration of DM, and dietary adherence were the associated factors of glycemic control. Appropriate attention shall be given for glycemic control especially for patients with a longer duration. Health promotion related to medical recommendations is a cross-cutting intervention for diabetic patients and should be provided for all type II diabetic patients.
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Affiliation(s)
| | | | - Asnakew Achaw Ayele
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Henok Getachew Tegegn
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Ethiopia
- School of Medicine and Pharmacy, University of New England, Armidale, NSW, 2351, Australia
| | - Belete Achamyelew Ayele
- Department of Epidemiology and Biostatics, Institute of Public Health College of Medicine and Health Science, University of Gondar, Ethiopia
| | - MelakuTadege Engidaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Ethiopia
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Carnero Contentti E, López PA, Alonso R, Eizaguirre B, Pettinicchi JP, Tizio S, Tkachuk V, Caride A. Coping strategies used by patients with relapsing multiple sclerosis from Argentina: correlation with quality of life and clinical features. Neurol Res 2020; 43:126-132. [PMID: 33040711 DOI: 10.1080/01616412.2020.1831304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic neurodegenerative and inflammatory disease. The adaptation to MS depends on the effectiveness of coping, which moderates the process of adaptation and psychological well-being. OBJECTIVES We aimed to analyze the coping strategies of an Argentinean population of patients with MS (PwMS) and their association with clinical variables and health-related quality of life (QoL). METHODS A nationwide cross-sectional study. Screening instruments: Demographics and clinical data, coping strategies (Brief Coping Orientation to Problems Experienced, [COPE-28]), health-related QoL (MS Impact Scale, [MSIS-29]), Fatigue Severity Scale, and physical disability (self-administrated Expanded Disability Status Scale, [EDSS]). RESULTS We included 249 PwMS. Most responders were female (74.7%) with a mean age at survey of 38.6 (±10.7) and had a MS duration of 7.3 years (range: 1-43 years) and a mean EDSS of 1.9 (±1.8). Younger age (r = -0.17), active MS (r = 0.25), higher fatigue (r = 0.22), MSIS-29 total (r = 0.34), MSIS-physical (r = 0.26), MSIS-psychological scores (r = 0.44), higher scores for perception of both severity of MS (r = 0.12) and wheelchair-dependency (r = 0.14) correlated significantly with the use of maladaptive coping strategies. However, active MS (β2.10, p = 0.01), MSIS-psychological score (β0.28, p < 0.0001), high education level (β - 1.15, p = 0.04), and EDSS (β - 0.84, p = 0.0001) were independent predictors of the utilization of maladaptive coping strategies after having applied multivariate analysis via linear regression. CONCLUSIONS Maladaptive coping strategies used by PwMS are associated with relevant clinical aspects of the disease and with worse health-related QoL scores.
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Affiliation(s)
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán , Buenos Aires, Argentina
| | - Ricardo Alonso
- Universitary Center of Multiple Sclerosis, Neurology Department, Hospital J.M. Ramos Mejía, Faculty of Medicine, University of Buenos Aires , Buenos Aires, Argentina.,Neurology Department, Universitary Hospital Sanatorio Guemes, Faculty of Medicine, University of Buenos Aires , Buenos Aires, Argentina
| | - Barbara Eizaguirre
- Universitary Center of Multiple Sclerosis, Neurology Department, Hospital J.M. Ramos Mejía, Faculty of Medicine, University of Buenos Aires , Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán , Buenos Aires, Argentina
| | - Santiago Tizio
- Neuroimmunology Section, Neurology Department, Hospital De Clínicas 'José De San Martín', University of Buenos Aires , Buenos Aires, Argentina
| | - Verónica Tkachuk
- Neurology Department, Hospital Italiano Y Español De La Plata , La Plata, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán , Buenos Aires, Argentina
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Studying ALS: Current Approaches, Effect on Potential Treatment Strategy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1241:195-217. [PMID: 32383122 DOI: 10.1007/978-3-030-41283-8_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is one of the most common neurodegenerative diseases, characterized by inevitable progressive paralysis. To date, only two disease modifying therapeutic options are available for the patients with ALS, although they show very modest effect on disease course. The main reason of failure in the field of pharmacological correction of ALS is inability to untangle complex relationships taking place during ALS initiation and progression. Traditional methods of research, based on morphology or transgenic animal models studying provided lots of information about ALS throughout the years. However, translation of these results to humans was unsuccessful due to incomplete recapitulation of molecular pathology and overall inadequacy of the models used in the research.In this review we summarize current knowledge regarding ALS molecular pathology with depiction of novel methods applied recently for the studies. Furthermore we describe present and potential treatment strategies that are based on the recent findings in ALS disease mechanisms.
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Burke T, Vucic S, Patching J. "Taming the Beast": Exploring the Lived Experience of Relapsing Remitting Multiple Sclerosis Using a Life History Approach. Res Theory Nurs Pract 2020; 33:229-245. [PMID: 31615943 DOI: 10.1891/1541-6577.33.3.229] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to gain insights and understanding into the lived experience of relapsing remitting multiple sclerosis (RRMS) in order to better inform patient-centerd nursing and healthcare. METHODS This qualitative study used life history methodology, a form of focused ethnography, to explore the life history of 13 study participants living with RRMS. Semi-structured interviews were transcribed and analysed using thematic analysis. FINDINGS A total of eight key themes emerged, explaining the journey of living with RRMS. Commencing with "Piecing Together the Puzzle" of symptoms at the beginning of the RRMS journey, followed by "(Re)defining ME now that I have RRMS," "Battling the Demons," the experiences of "Surplus Suffering," negotiating "High Invisibility," gaining control by "Taming the Beast," learning "The DMT Dance," and ultimately "Holding Hands with Hope," expressing hope and practising purposeful positivity. IMPLICATIONS FOR PRACTICE The eight key themes of living with RRMS were reflective of the ebbs and flows of life. By gaining these insights into the world of people living with RRMS, it is anticipated that clinical nursing care and quality of life for people living with this chronic neurological disease may be improved.
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Affiliation(s)
- Therese Burke
- School of Nursing, The University of Notre Dame, Sydney, Australia
| | - Steve Vucic
- Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Joanna Patching
- School of Nursing, The University of Notre Dame, Sydney, Australia
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Ness NH, Haase R, Kern R, Schriefer D, Ettle B, Cornelissen C, Akguen K, Ziemssen T. The Multiple Sclerosis Health Resource Utilization Survey (MS-HRS): Development and Validation Study. J Med Internet Res 2020; 22:e17921. [PMID: 32181745 PMCID: PMC7109610 DOI: 10.2196/17921] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023] Open
Abstract
Background Survey-based studies are frequently used to describe the economic impact of multiple sclerosis (MS). However, there is no validated health resource survey available, preventing comparison of study results and meaningful conclusions regarding the efficiency of long-term treatments. Objective The aim of this study was to develop and validate a tablet- and paper-based MS health resource utilization survey. Methods We developed and validated the Multiple Sclerosis Health Resource Utilization Survey (MS-HRS), consisting of 24 cost items for paper and tablet users. Data for validation came from two large German observational studies. Survey practicability was assessed according to the response rate. Reliability was described using test-retest reliability as well as Guttman lambda. Construct validity was assessed as convergent and discriminant validity via correlations with associated patient-reported outcomes and known-group analyses. Results In total, 2207 out of 2388 (response rate: 92.4%) patients completed the survey and were included to determine psychometric properties. The test-retest reliability had an intraclass correlation coefficient of 0.828 over a course of 3 months. Convergent validity analyses showed that total costs correlated positively with increased disability (r=0.411, P<.001). For discriminant validity, correlations of total costs with the Treatment Satisfaction Questionnaire for Medication ranged from −0.006 (convenience) to −0.216 (effectiveness). The mean annual cost was €28,203 (SD €14,808) (US $39,203; SD US $20,583) with disease-modifying therapies. Conclusions The MS-HRS is a multilingual, reliable, valid, electronically available, and easy-to-administer questionnaire providing a holistic cross-sectional and longitudinal assessment of resource utilization in patients with MS.
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Affiliation(s)
| | - Rocco Haase
- University Hospital Carl Gustav Carus, Dresden, Germany
| | | | | | | | | | - Katja Akguen
- University Hospital Carl Gustav Carus, Dresden, Germany
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Ghafoori F, Dehghan-Nayeri N, Khakbazan Z, Hedayatnejad M, Nabavi SM. Pregnancy and Motherhood Concerns Surrounding Women with Multiple Sclerosis: A Qualitative Content Analysis. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2020; 8:2-11. [PMID: 32039275 PMCID: PMC6969949 DOI: 10.30476/ijcbnm.2019.73900.0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background There is a high prevalence of multiple sclerosis (MS) among Iranian women of reproductive age. However, very few studies have been conducted in Iran to assess the experiences with and concerns about pregnancy and motherhood of such patients. The present study was conducted to better understand the experiences and concerns of women with MS about pregnancy and motherhood. Methods The present qualitative study was conducted from August 2016 to January 2017 among Iranian women with MS visiting the Iran MS Society in Tehran, Iran. The purposive sampling method was used to recruit the participants and the sampling was continued until data saturation. Based on the inclusion criteria, a total of 25 women with MS were recruited in the study. The data were collected by in-depth semi-structured face-to-face interviews and analyzed using the MAXQDA 10 software. Results The analysis of the interview data resulted in four main categories, namely "Pregnancy concerns", "Fear of failing as a parent", "Feeling of threatened fertility", and "Lack of social support". The results showed that Iranian women with MS avoided pregnancy due to the negative effects of the disease on their physical abilities and on life in general. They were also concerned about possible infertility, the effect of MS medications on their menstrual cycle, and the limitations of infertility treatments due to the presence of MS. These concerns led them to postpone pregnancy and lose time or opt for voluntary childlessness and consequently miss out on the experience of motherhood. Conclusion MS poses a serious challenge to women who consider getting pregnant and wish to experience motherhood. Health care professionals should support such patients to overcome their concerns and indecisiveness by providing appropriate information and counseling.
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Affiliation(s)
- Faezeh Ghafoori
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.,Ministery of Health and Medical Education, Tehran, Iran
| | - Nahid Dehghan-Nayeri
- Department of Nursing Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Khakbazan
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Seyed Massood Nabavi
- Department of Brain and Cognitive Sciences, Royan Institute for Stem Cell Biology and Technology, Royan Institute, Tehran, Iran
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22
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Andrejew R, Glaser T, Oliveira-Giacomelli Á, Ribeiro D, Godoy M, Granato A, Ulrich H. Targeting Purinergic Signaling and Cell Therapy in Cardiovascular and Neurodegenerative Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1201:275-353. [PMID: 31898792 DOI: 10.1007/978-3-030-31206-0_14] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Extracellular purines exert several functions in physiological and pathophysiological mechanisms. ATP acts through P2 receptors as a neurotransmitter and neuromodulator and modulates heart contractility, while adenosine participates in neurotransmission, blood pressure, and many other mechanisms. Because of their capability to differentiate into mature cell types, they provide a unique therapeutic strategy for regenerating damaged tissue, such as in cardiovascular and neurodegenerative diseases. Purinergic signaling is pivotal for controlling stem cell differentiation and phenotype determination. Proliferation, differentiation, and apoptosis of stem cells of various origins are regulated by purinergic receptors. In this chapter, we selected neurodegenerative and cardiovascular diseases with clinical trials using cell therapy and purinergic receptor targeting. We discuss these approaches as therapeutic alternatives to neurodegenerative and cardiovascular diseases. For instance, promising results were demonstrated in the utilization of mesenchymal stem cells and bone marrow mononuclear cells in vascular regeneration. Regarding neurodegenerative diseases, in general, P2X7 and A2A receptors mostly worsen the degenerative state. Stem cell-based therapy, mainly through mesenchymal and hematopoietic stem cells, showed promising results in improving symptoms caused by neurodegeneration. We propose that purinergic receptor activity regulation combined with stem cells could enhance proliferative and differentiation rates as well as cell engraftment.
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Affiliation(s)
- Roberta Andrejew
- Neuroscience Laboratory, Institute of Chemistry, Department of Biochemistry, University of São Paulo, São Paulo, Brazil
| | - Talita Glaser
- Neuroscience Laboratory, Institute of Chemistry, Department of Biochemistry, University of São Paulo, São Paulo, Brazil
| | - Ágatha Oliveira-Giacomelli
- Neuroscience Laboratory, Institute of Chemistry, Department of Biochemistry, University of São Paulo, São Paulo, Brazil
| | - Deidiane Ribeiro
- Neuroscience Laboratory, Institute of Chemistry, Department of Biochemistry, University of São Paulo, São Paulo, Brazil
| | - Mariana Godoy
- Neuroscience Laboratory, Institute of Chemistry, Department of Biochemistry, University of São Paulo, São Paulo, Brazil.,Laboratory of Neurodegenerative Diseases, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alessandro Granato
- Neuroscience Laboratory, Institute of Chemistry, Department of Biochemistry, University of São Paulo, São Paulo, Brazil
| | - Henning Ulrich
- Neuroscience Laboratory, Institute of Chemistry, Department of Biochemistry, University of São Paulo, São Paulo, Brazil.
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23
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Du Y, Min R, Zhang X, Fang P. Factors associated with the healthcare expenditures of patients with multiple sclerosis in urban areas of China estimated by a generalized estimating equation. Expert Rev Pharmacoecon Outcomes Res 2020; 21:137-144. [PMID: 31984811 DOI: 10.1080/14737167.2020.1722103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background: Multiple sclerosis (MS) has a significant healthcare burden. This study examined the medical cost and out-of-pocket (OOP) expenses, and quantified the impact factors contributing to the costs. Methods: This is a retrospective study in 77 Chinese urban cites from 2013 to 2015. The data included the details of the utilization of medical resources, cost, and reimbursement ratio of all patients with a diagnosis of MS. A generalized estimating equation model was used to estimate the factors influencing the direct medical cost and OOP expenses for in- and outpatients. Results: A total of 267 patients with MS were identified. The mean cost per in- and outpatient was respectively 16996.2 and 2294.2 renminbi ($2768.12 and $373.65, €2087.16 and €281.73). Approximately 27% of the expenses were paid by the patients OOP. Factors contributing to high cost and high OOP expenses for inpatients were tertiary hospital admission, length of stay and residence in the east regions of China. Females and outpatients with resident insurance paid more OOP. Conclusion: This study illustrates the medical costs and burden of MS in Chinese patients and provides real-world data on MS that are essential for the improvement of health policies.
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Affiliation(s)
- Yaling Du
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei, China.,First Affiliated Hospital, School of Medicine, Shihezi University , Shihezi, Xinjiang, China
| | - Rui Min
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei, China
| | - Xiaoyan Zhang
- School of Political Science and Public Administration, Hubei University , Wuhan, Hubei, China
| | - Pengqian Fang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei, China.,Academy of Health Policy and Management, Huazhong Unversity of Science and Technology , Wuhan, Hubei Province, China
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24
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Carnero Contentti E, López PA, Pettinicchi JP, Alonso R, Tizio S, Tkachuk V, Caride A, Galea I. Do people with multiple sclerosis want to discuss their long-term prognosis? A nationwide study in Argentina. Mult Scler Relat Disord 2020; 37:101445. [DOI: 10.1016/j.msard.2019.101445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 11/17/2022]
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25
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Bruno D, Marc D, Ouarda P, Dominique S, Marc S, Laurène C, Khalil J, Jonathan E, Francis G. Economic burden of multiple sclerosis in France estimated from a regional medical registry and national sick fund claims. Mult Scler Relat Disord 2019; 36:101396. [DOI: 10.1016/j.msard.2019.101396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 08/22/2019] [Accepted: 09/08/2019] [Indexed: 10/26/2022]
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26
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Carnero Contentti E, Pettinicchi JP, Caride A, López PA. Sexual Dysfunction in Patients with Multiple Sclerosis from Argentina: What are the Differences Between Women and Men? SEXUALITY AND DISABILITY 2019. [DOI: 10.1007/s11195-019-09603-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Schmidt S, Jöstingmeyer P. Depression, fatigue and disability are independently associated with quality of life in patients with multiple Sclerosis: Results of a cross-sectional study. Mult Scler Relat Disord 2019; 35:262-269. [DOI: 10.1016/j.msard.2019.07.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/08/2019] [Accepted: 07/27/2019] [Indexed: 11/17/2022]
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28
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van Mastrigt GA, Evers SM, Heerings M, Visser LH, Ruimschotel RP, Hussaarts A, Duyverman L, Valkenburg-Vissers J, Cornelissen J, Bos M, van Droffelaar M, Jongen PJ. An economic evaluation attached to a single-centre, parallel group, unmasked, randomized controlled trial of a 3-day intensive social cognitive treatment (can do treatment) in patients with relapsing remitting multiple sclerosis and low disability. J Med Econ 2019; 22:967-980. [PMID: 31084442 DOI: 10.1080/13696998.2019.1609300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aims: This trial-based economic evaluation (EE) assesses from a societal perspective the cost-effectiveness of an intensive 3-day cognitive theory-based intervention (CDT), compared to care-as-usual, in patients with relapsing remitting multiple sclerosis (RRMS) and low disability (Expanded Disability Status Scale [EDDS] score < 4.0). Materials and methods: The trial of the EE was registered in the Dutch Trial Register: Trial NL5158 (NTR5298). The incremental cost-effectiveness ratio (ICER) was expressed in cost on the Control sub-scale of the Multiple Sclerosis Self-Efficacy Scale (MSSES) and the incremental cost-utility ratio (ICUR) in the cost per Quality Adjusted Life Years (QALY) using the EQ-5D-5L. Bootstrap, sensitivity, and sub-group analyses were performed to determine the robustness of the findings. Results: The two groups of 79 patients were similar in baseline characteristics. The base case ICER is situated in the northeast quadrant (€72 (40.74/€2,948)) due to a higher MSSES Control score and higher societal costs in the CDT group. The ICUR is situated in the northwest (inferior) quadrant due to losses in QALY and higher societal costs for the CDT group (-0.02/€2,948). Overall, bootstrap, sensitivity, and sub-group analyses confirm the base case findings. However, when the SF-6D is used as a study outcome, there is a high probability that the ICUR is situated in the northeast quadrant. Limitations: The relative short follow-up time (6 months) and the unexpected increase in MSSES Control in the control group. Conclusions: When using the EQ-5D-5L to calculate a QALY, CDT is not a cost-effective alternative in comparison to care as usual. However, when using self-efficacy or SF-6D as outcomes, there is a probability that CDT is cost-effective. Based on the current results, CDT for patients with RRMS clearly show its potential. However, an extended follow-up for the economic evaluation is warranted before a final decision on implementation can be made.
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Affiliation(s)
- Ghislaine A van Mastrigt
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands
| | - Silvia M Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands
- Department of Public Mental Healthcare, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Center for Economic Evaluations , Utrecht , The Netherlands
| | - Marco Heerings
- National Multiple Sclerosis Foundation , Rotterdam , The Netherlands
| | - Leo H Visser
- Department of Neurology, St. Elisabeth Hospital , Tilburg , The Netherlands
- University of Humanistic Studies , Utrecht , The Netherlands
| | | | - Astrid Hussaarts
- National Multiple Sclerosis Foundation , Rotterdam , The Netherlands
| | - Lotte Duyverman
- Medical Psychiatric Centre PsyToBe , Rotterdam , The Netherlands
| | | | | | - Michel Bos
- Department of Neurology, St. Anna Hospital , Geldrop , The Netherlands
| | | | - Peter J Jongen
- Department of Community & Occupational Medicine, University Medical Centre Groningen , Groningen , The Netherlands
- MS4 Research Institute , Nijmegen , The Netherlands
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Ysrraelit MC, Fiol MP, Peña FV, Vanotti S, Terrasa SA, Tran VT, Montori VM, Correale J. Adaptation and validation of a Spanish version of the treatment burden questionnaire in patients with multiple sclerosis. BMC Neurol 2019; 19:209. [PMID: 31455235 PMCID: PMC6710872 DOI: 10.1186/s12883-019-1441-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/21/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The Treatment Burden Questionnaire (TBQ) is a self-reported measure of the effect of treatment workload on patient wellbeing. We sought to validate the TBQ in Spanish and use it to estimate the burden of treatment in Argentinian patients with multiple sclerosis (MS). METHODS The TBQ was forward-backward translated into Spanish. Two focus groups and 25 semi-structured interviews focused on wording and possible item exclusion. Validation was performed in 2 steps. First, 162 patients across a range of MS severity completed the questionnaire. Confirmatory factor analysis assessed the dimensional structure of the TBQ. Construct validity was assessed by studying correlations with fatigue and quality of life (QoL). Then, in a second cohort of 171 patients, we evaluated the association between TBQ scores and patients' sex, age, education level, employment status, type of MS, disease duration, comorbidities, EDSS, pharmacological treatment and medication adherence. RESULTS The questionnaire presented a 3-factor structure in which burden was related to pharmacological treatment; comprehensive health assistance; and psycho-social-economic context. Composite reliability was > 0.8 for all factors. TBQ showed positive correlation with fatigue (rs = 0.467, p = 0.006), negative correlation with QoL (rs - 0.446, p = 0.009). For the second cohort, total TBQ score was 43 (SD 29). Lowest scores were observed on self-monitoring (0.53, SD 1.3) and highest for administrative load (4.2, SD 3.4). Inverse association was found between the TBQ score and medication adherence (r 0.243 p = 0.001). TBQ scores also correlated with daily patient pill/injection requirements (r 0.175 p = 0.020). Individuals receiving injectable treatment scored higher than patients on oral drugs (total TBQ 51 (SD 32) vs 39 (SD 27) p = 0.002). CONCLUSIONS The TBQ in Spanish is a reliable instrument and showed adequate correlation with QoL and adherence scales in MS patients. TBQ may benefit health resources allocation and provide tailor therapeutic interventions to construct a minimally disruptive care.
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Affiliation(s)
| | | | | | - Sandra Vanotti
- Multiple Sclerosis Clinic, INEBA - Neurosciences Institute of Buenos Aires, Buenos Aires, Argentina
| | | | - Viet-Thi Tran
- Centre of Research in Epidemiology and Statistics (CRESS – UMR 1153), Paris, France
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905 USA
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Access and unmet needs to multiple sclerosis care in a cohort of Argentinean patients. Mult Scler Relat Disord 2019; 33:88-93. [DOI: 10.1016/j.msard.2019.05.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 05/14/2019] [Accepted: 05/29/2019] [Indexed: 02/03/2023]
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Rae-Grant AD. Incorporating Clinical Practice Guidelines and Quality Measures Into High-Quality Cost-Effective Care for Patients With Multiple Sclerosis. Continuum (Minneap Minn) 2019; 25:845-849. [DOI: 10.1212/con.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Linker RA, Chan A. Navigating choice in multiple sclerosis management. Neurol Res Pract 2019; 1:5. [PMID: 33324871 PMCID: PMC7650058 DOI: 10.1186/s42466-019-0005-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/21/2018] [Indexed: 01/10/2023] Open
Abstract
Background With the advent of modern immunotherapies for relapsing-remitting multiple sclerosis (RRMS) and the increasing amount of treatment options on the market, MS has evolved as a treatable disease. Yet, at the same time, new challenges for the treating neurologists arise. Main body This review article covers some of these challenges, including when and how to start treatment, treatment monitoring, and finally considerations on what the increasing choice in treatment options brings to disease management and longer-term planning. Among others, these important issues comprise pregnancy, treatment sequencing, switching or even stopping treatment. Conclusion The ultimate goal for navigating choices in RRMS management is to choose the right drug for the right patient at the right time Throughout the article, there is a strong focus on practical aspects and individual decision making in MS to meet the concept of personalized medicine.
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Affiliation(s)
- Ralf A Linker
- Department of Neurology, University of Regensburg, Universitätsstr. 84, 93053 Regensburg, Germany
| | - Andrew Chan
- Ambulantes Neurozentrum, Inselspital, Bern University Hospital, Freiburgstr. 4, 3010 Bern, Switzerland
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Kobelt G, Teich V, Cavalcanti M, Canzonieri AM. Burden and cost of multiple sclerosis in Brazil. PLoS One 2019; 14:e0208837. [PMID: 30673707 PMCID: PMC6343964 DOI: 10.1371/journal.pone.0208837] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 11/25/2018] [Indexed: 01/22/2023] Open
Abstract
Background The objective of this study was to estimate costs to society and patients’ quality of life (QoL) at all levels of disease severity (measured with the Expanded Disability Status Scale, EDSS) in Brazil. Methods The study was part of an international, cross-sectional burden-of-illness study carried out in collaboration with national MS patient organizations. All information was collected directly from patients using a validated questionnaire. Direct costs were estimated both from societal and payer perspectives, while total costs are presented as societal costs. Results The survey included 694 patients (response rate 21%; mean age 40.8 years). 95% of patients were of working age, and around half were working. The mean EDSS score was 3.2 (62.5% of patients with EDSS <3). Relapses were reported by 18.9% of patients. Fatigue affected almost all patients (94%) regardless of EDSS level, and cognitive difficulties were reported by 69.1% of patients. Mean utility ranged from 0.77 at EDSS 0 to negative values at EDSS 9, with a mean score of 0.58; utility was affected by relapses. Total mean annual cost was R$33,872 (€ 8,000) per patient in the societal perspective, with direct costs representing 81% (R$ 27,355, € 6,500). Direct costs for the payer amounted to R$ 16,793 (€ 4,000)/patient. Conclusions This study included a population with relatively mild and early disease, with a majority of patients with relapsing disease and thus on DMD treatment. It is not possible to conclude directly on the total cost of MS in Brazil. Nevertheless, resource quantities used, QoL and MS symptoms are very similar to what was seen in the European survey.
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Affiliation(s)
- Gisela Kobelt
- European Health Economics, Stockholm, Sweden
- * E-mail:
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Gavrilov YV, Shkilnyuk GG, Valko PO, Stolyarov ID, Ivashkova EV, Ilves AG, Nikiforova IG, Shchelkova OY, Vasserman LI, Vais EE, Valko Y. Validation of the Russian version of the Fatigue Impact Scale and Fatigue Severity Scale in multiple sclerosis patients. Acta Neurol Scand 2018; 138:408-416. [PMID: 29984406 DOI: 10.1111/ane.12993] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 06/15/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fatigue is a common complaint in patients with multiple sclerosis (MS), and its detection and monitoring are based on self-reported questionnaires. The objective of this study was to validate the Russian translation of the Fatigue Impact Scale (FIS) and the Fatigue Severity Scale (FSS) in MS patients and controls. METHODS We included 85 MS patients and 250 age-, sex-, and body mass index (BMI)-matched controls. We ascertained in all subjects levels of education, marital status, and comorbidities, such as sleepiness (using the Epworth Sleepiness Scale, ESS), anxiety and depression (using the Hospital Anxiety and Depression Scale, HADS). The expanded disability status scale (EDSS) reflected physical disability in MS. RESULTS The Russian versions of the three FIS subscales (cognitive, physical, and psychosocial) and FSS had excellent internal consistencies (Cronbach's α coefficients 0.88-0.96), and good test-retest stability with intraclass coefficients between 0.78 and 0.89. Both convergent and discriminant validity of the Russian FIS and FSS appeared to be good, as expressed by strong inter-correlations between FIS subscales and FSS, and by absent associations between fatigue scales and BMI. Principal components analysis and scree plots indicated unidimensional structures of the physical and cognitive FIS subscales and FSS, but a multidimensional structure of the psychosocial subscale. We identified EDSS and anxiety scores as independent predictors of more severe fatigue in MS. SIGNIFICANCE The Russian FIS and FSS represent reliable and valid tools for efficient quantification and monitoring of fatigue severity and its clinical impact in MS. EDSS and anxiety are important contributors to fatigue severity in MS.
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Affiliation(s)
- Yury V. Gavrilov
- Department of General Pathology and Pathological Physiology; Institute of Experimental Medicine; St. Petersburg Russia
| | - Galina G. Shkilnyuk
- Center of Multiple Sclerosis IHB RAS; N.P. Bekhtereva Human Brain Institute of the Russian Academy of Sciences; St. Petersburg Russia
| | - Philipp O. Valko
- Department of Neurology; Clinical Neuroscience Center; University Hospital Zurich; University of Zurich; Zurich Switzerland
| | - Igor D. Stolyarov
- Center of Multiple Sclerosis IHB RAS; N.P. Bekhtereva Human Brain Institute of the Russian Academy of Sciences; St. Petersburg Russia
| | - Elena V. Ivashkova
- Center of Multiple Sclerosis IHB RAS; N.P. Bekhtereva Human Brain Institute of the Russian Academy of Sciences; St. Petersburg Russia
| | - Alexandr G. Ilves
- Center of Multiple Sclerosis IHB RAS; N.P. Bekhtereva Human Brain Institute of the Russian Academy of Sciences; St. Petersburg Russia
| | - Irina G. Nikiforova
- Center of Multiple Sclerosis IHB RAS; N.P. Bekhtereva Human Brain Institute of the Russian Academy of Sciences; St. Petersburg Russia
| | - Olga Y. Shchelkova
- Department of Medical Psychology and Psychophysiology; St. Petersburg State University; St. Petersburg Russia
| | - Ludvig I. Vasserman
- Department of Medical Psychology and Psychophysiology; St. Petersburg State University; St. Petersburg Russia
| | - Evelina E. Vais
- Department of Medical Psychology and Psychophysiology; St. Petersburg State University; St. Petersburg Russia
| | - Yulia Valko
- Department of Neurology; Clinical Neuroscience Center; University Hospital Zurich; University of Zurich; Zurich Switzerland
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Killner L, Soundy A. Motivation and experiences of role transition in spousal caregivers of people with multiple sclerosis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.8.405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lauren Killner
- Physiotherapist, School of Sport Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Andrew Soundy
- Lecturer in physiotherapy, School of Sport Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Barin L, Salmen A, Disanto G, Babačić H, Calabrese P, Chan A, Kamm CP, Kesselring J, Kuhle J, Gobbi C, Pot C, Puhan MA, von Wyl V. The disease burden of Multiple Sclerosis from the individual and population perspective: Which symptoms matter most? Mult Scler Relat Disord 2018; 25:112-121. [PMID: 30059895 DOI: 10.1016/j.msard.2018.07.013] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/22/2018] [Accepted: 07/08/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND MS symptoms affect many functional domains. Knowing the specific impact of symptoms on health-related quality of life (HRQoL) is vital for successful disease and symptom management in MS. We aimed at investigating how specific MS symptoms contribute to the disease burden in individuals and from a population perspective. METHODS We included 855 Swiss Multiple Sclerosis Registry participants with a relapsing-remitting form (RRMS) or a progressive form (PMS). HRQoL was measured with the EuroQol 5-Dimension EQ-5D-index and EQ-Visual Analogue Scale (EQ-VAS) on 0-100% scales. Their associations with 20 symptoms, socio-demographic and clinical information were explored in median regression models, stratified by RRMS and PMS. RESULTS We included 611 participants with RRMS and 244 with PMS. In RRMS, gait (-6.5%) and balance problems (-5.1%) had the largest EQ-5D-index reductions, and were also important at the population level (frequencies 45% and 52%). Fatigue, depression, and spasticity (frequencies 74.1%, 31%, 38%) also contributed to the population disease burden. In PMS, spasticity, paralysis, and bowel problems had the largest impact on EQ-5D-index, both at the individual and population levels. The largest impact on EQ-VAS at population level was associated in RRMS with balance problems, depression, dizziness, and spasticity, while in PMS with weakness, pain, and paralysis. CONCLUSIONS While HRQoL at population level is most affected by balance problems, spasticity, and depression in RRMS, the biggest HRQoL losses in PMS are caused by spasticity, paralysis, weakness, and pain. Many symptoms with the largest effects in individuals substantially contribute to the population disease burden.
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Affiliation(s)
- Laura Barin
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Anke Salmen
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland.
| | - Giulio Disanto
- Neurocenter of southern Switzerland, Ospedale regionale di Lugano, Lugano, Switzerland; Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Haris Babačić
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Pasquale Calabrese
- Neuropsychology and Behavioral Neurology Unit, Division of Molecular and Cognitive Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland.
| | - Andrew Chan
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland.
| | - Christian P Kamm
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland; Neurology and Neurorehabilitation Centre, Luzerner Kantonsspital, Lucerne, Switzerland.
| | - Jürg Kesselring
- Department of Neurology & Neurorehabilitation, Rehabilitation Centre Kliniken Valens, Valens, Switzerland.
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Claudio Gobbi
- Neurocenter of southern Switzerland, Ospedale regionale di Lugano, Lugano, Switzerland.
| | - Caroline Pot
- Laboratories of Neuroimmunology, Division of Neurology and Neuroscience Research Center, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland.
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
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Gyllensten H, Kavaliunas A, Alexanderson K, Hillert J, Tinghög P, Friberg E. Costs and quality of life by disability among people with multiple sclerosis: a register-based study in Sweden. Mult Scler J Exp Transl Clin 2018; 4:2055217318783352. [PMID: 30090640 PMCID: PMC6077913 DOI: 10.1177/2055217318783352] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Population-based estimates of costs of illness and health-related quality of life, by disability levels among people with multiple sclerosis, are lacking. Objectives To estimate the annual costs of illness and health-related quality of life, by disability levels, among multiple sclerosis patients, 21–64 years of age. Methods Microdata from Swedish nationwide registers were linked to estimate the prevalence-based costs of illness in 2013, including direct costs (prescription drug use and specialised healthcare) and indirect costs (calculated using sick leave and disability pension), and health-related quality of life (estimated from the EQ-5D). Disability level was measured by the Expanded Disability Status Scale (EDSS). Results Among 8906 multiple sclerosis patients, EDSS 0.0–3.5 and 7.0–9.5 were associated with mean indirect costs of SEK 117,609 and 461,357, respectively, whereas direct costs were similar between the categories (SEK 117,423 and 102,714, respectively). Prescription drug costs represented 40% of the costs of illness among multiple sclerosis patients with low EDSS, while among patients with high EDSS more than 80% were indirect costs. Among the 1684 individuals who had reported both EQ-5D and EDSS, the lowest health-related quality of life scores were found among those with a high EDSS. Conclusion Among people with multiple sclerosis, we confirmed higher costs and lower health-related quality of life in higher disability levels, in particular high indirect costs.
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Affiliation(s)
- Hanna Gyllensten
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden.,Centre for Person-centred Care (GPCC) and Institute of Health and Care Sciences, University of Gothenburg, Sweden
| | | | | | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden.,Department of Research and Education, Karolinska University Hospital, Sweden
| | - Petter Tinghög
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden.,Department of Public Health and Medicine, Red Cross University College, Sweden
| | - Emilie Friberg
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
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Mao Z, Álvarez-Gonzalez C, De Trane S, Yildiz O, Albor C, Doctor G, Soon D, Pepper G, Turner BP, Marta M, Mathews J, Giovannoni G, Baker D, Schmierer K. Cladribine: Off-label disease modification for people with multiple sclerosis in resource-poor settings? Mult Scler J Exp Transl Clin 2018; 4:2055217318783767. [PMID: 30090639 PMCID: PMC6077935 DOI: 10.1177/2055217318783767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/19/2018] [Accepted: 05/04/2018] [Indexed: 01/13/2023] Open
Abstract
Background A considerable number of people with multiple sclerosis (pwMS) live in low- and middle-income countries (LMIC), where lack of resource adversely affects access to effective disease-modifying treatment. Objective The objective of this commentary is to propose a useful cost-effective disease-modifying treatment option for pwMS in LMIC with potential high efficacy and high convenience to the pwMS and treating physician. Viewpoint: We propose using generic 2-chloro-2’-deoxyadenosine (cladribine), a small molecule licensed for treatment of people with hairy cell leukaemia, as a solution of this significant equity imbalance. Cladribine has been shown in phase II and III trials to be a highly effective disease-modifying treatment for pwMS, and its adverse effect profile is comparable with any DMT currently licensed in high-income economies where an oral preparation has recently been licensed by the European Medicines Agency. Conclusion Our viewpoint takes into account experience we have gathered over the past three years in the use of generic cladribine to treat pwMS. Whilst here we focus on MS, there is significant potential for use of cladribine in other conditions that could benefit from its mechanism of action.
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Affiliation(s)
- Zhifeng Mao
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-Sen University, China.,BartsMS, Blizard Institute, Queen Mary University of London, United Kingdom
| | - César Álvarez-Gonzalez
- BartsMS, Blizard Institute, Queen Mary University of London, United Kingdom.,Emergency Care & Acute Medicine Clinical Academic Group Neuroscience, The Royal London Hospital, Barts Health NHS Trust, United Kingdom
| | - Stefania De Trane
- BartsMS, Blizard Institute, Queen Mary University of London, United Kingdom.,Emergency Care & Acute Medicine Clinical Academic Group Neuroscience, The Royal London Hospital, Barts Health NHS Trust, United Kingdom
| | - Ozlem Yildiz
- BartsMS, Blizard Institute, Queen Mary University of London, United Kingdom.,Emergency Care & Acute Medicine Clinical Academic Group Neuroscience, The Royal London Hospital, Barts Health NHS Trust, United Kingdom
| | - Christo Albor
- BartsMS, Blizard Institute, Queen Mary University of London, United Kingdom
| | - Gabriel Doctor
- BartsMS, Blizard Institute, Queen Mary University of London, United Kingdom
| | - Derek Soon
- Division of Neurology, National University Hospital, Singapore
| | | | - Benjamin P Turner
- BartsMS, Blizard Institute, Queen Mary University of London, United Kingdom.,Emergency Care & Acute Medicine Clinical Academic Group Neuroscience, The Royal London Hospital, Barts Health NHS Trust, United Kingdom
| | - Monica Marta
- BartsMS, Blizard Institute, Queen Mary University of London, United Kingdom.,Emergency Care & Acute Medicine Clinical Academic Group Neuroscience, The Royal London Hospital, Barts Health NHS Trust, United Kingdom
| | - Joela Mathews
- Barts Health NHS Trust, Pharmacy, The Royal London Hospital, United Kingdom
| | - Gavin Giovannoni
- BartsMS, Blizard Institute, Queen Mary University of London, United Kingdom.,Clinical Board:Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, United Kingdom
| | - David Baker
- BartsMS, Blizard Institute, Queen Mary University of London, United Kingdom
| | - Klaus Schmierer
- BartsMS, Blizard Institute, Queen Mary University of London, United Kingdom.,Clinical Board:Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, United Kingdom
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Thompson A, Kobelt G, Berg J, Capsa D, Eriksson J, Miller D. New insights into the burden and costs of multiple sclerosis in Europe: Results for the United Kingdom. Mult Scler 2018. [PMID: 28643587 DOI: 10.1177/1352458517708687] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION In order to estimate the value of interventions in multiple sclerosis (MS) - where lifetime costs and outcomes cannot be observed - outcome data have to be combined with costs. This requires that cost data be regularly updated. OBJECTIVES AND METHODS This study is part of a cross-sectional retrospective study in 16 countries collecting data on resource consumption and work capacity, health-related quality of life (HRQoL) and prevalent symptoms for patients with MS. Descriptive analyses are presented by level of disability, from the societal perspective, in EUR (2015). RESULTS A total of 779 patients (mean age = 57 years) participated; 72% were below retirement age and of these, 36% were employed. Employment was related to disease severity, and MS affected productivity at work for 84% of patients. Overall, 96% and 72% of the patients experienced fatigue and cognition as a problem. Mean utility and annual costs were 0.735 and 11,400GBP at Expanded Disability Status Scale (EDSS) = 0-3, 0.534 and 22,700GBP at EDSS = 4-6.5, and 0.135 and 36,500GBP at EDSS = 7-9. The mean cost of a relapse was estimated at 790GBP. CONCLUSION This study illustrates the burden of MS on UK patients and provides current data on MS that are important for development of health policies.
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Affiliation(s)
- Alan Thompson
- UCL Institute of Neurology, University College London (UCL), London, UK
| | | | | | | | | | - David Miller
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London (UCL), London, UK
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Flachenecker P, Kobelt G, Berg J, Capsa D, Gannedahl M. New insights into the burden and costs of multiple sclerosis in Europe: Results for Germany. Mult Scler 2018. [PMID: 28643593 DOI: 10.1177/1352458517708141] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION To estimate the value of interventions in multiple sclerosis (MS) - where lifetime costs and outcomes cannot be observed - outcome data have to be combined with costs. This requires that cost data be regularly updated. OBJECTIVES AND METHODS This study is part of a cross-sectional retrospective study in 16 countries collecting data on resource consumption and work capacity, health-related quality of life (HRQoL) and prevalent symptoms for patients with MS. Descriptive analyses are presented by level of severity, from the societal perspective, in EUR 2015. RESULTS A total of 5475 patients (mean age 52 years) participated in Germany. In all, 84% were below retirement age, and of these, 51% were employed. Employment was related to disease severity, and MS affected productivity at work for 80% of patients. Overall, 96% and 78% of patients experienced fatigue and cognitive difficulties as a problem, respectively. The mean utility and total annual costs were 0.786 and 28,200€ at Expanded Disability Status Scale (EDSS) 0-3, 0.586 and €44,000 at EDSS 4-6.5 and 0.273 and €62,700 at EDSS 7-9, respectively. The mean cost of a relapse was estimated at €2500. CONCLUSION This study provides current health economic data on MS in Germany that are important for the development of health policies and for estimating the value of the current and future treatments.
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Sá MJ, Kobelt G, Berg J, Capsa D, Dalén J. New insights into the burden and costs of multiple sclerosis in Europe: Results for Portugal. Mult Scler 2018. [PMID: 28643585 DOI: 10.1177/1352458517708667] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In order to assess the value of management strategies in multiple sclerosis (MS), outcome data have to be combined with cost data. This, in turn, requires that cost data be regularly updated. OBJECTIVE AND METHODS This study is part of a cross-sectional retrospective study in 16 countries collecting current data on resource consumption, work capacity and health-related quality of life (HRQoL). Descriptive analyses are presented by level of severity; costs are estimated in the societal perspective, in EUR 2015. RESULTS A total of 535 patients (mean age 48.5 years) participated; 92% were below retirement age and of these, 43% were employed. Employment was related to disease severity, and MS was felt to affect productivity at work by 72% of patients, most often through fatigue. Overall, 98% and 74% of patients felt that fatigue and cognition were a problem. Mean utility and costs were 0.756 and €16,500 at the Expanded Disability Status Scale (EDSS) 0-3, 0.572 and €28,700 at EDSS 4-6.5 and 0.206 and €34,400 at EDSS 7-9. The average cost of a relapse was estimated at €2930. CONCLUSION This study illustrates the burden of MS on Portuguese patients and provides current data that are important for the development of health policies.
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Affiliation(s)
- Maria José Sá
- Department of Neurology, Centro Hospitalar de S. João, Porto, Portugal
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Oreja-Guevara C, Kobelt G, Berg J, Capsa D, Eriksson J. New insights into the burden and costs of multiple sclerosis in Europe: Results for Spain. Mult Scler 2018. [PMID: 28643597 DOI: 10.1177/1352458517708672] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION In order to estimate the value of interventions in multiple sclerosis (MS) where lifetime costs and outcomes cannot be observed, outcome data have to be combined with costs. This requires that cost data be regularly updated. OBJECTIVES AND METHODS This study is part of a cross-sectional retrospective study in 16 countries collecting data on resource consumption, work capacity, health-related quality of life (HRQoL) and prevalent symptoms for patients with MS. Descriptive analyses are presented by level of severity, from the societal perspective, in EUR 2015. RESULTS A total of 462 patients (mean age 43 years) participated in Spain; 96% were below retirement age and of these, 45% were employed. Employment was related to disability, and MS affected productivity at work for 72% of those working. Overall, 92% and 64% of patients experienced fatigue and cognitive difficulties as a problem, respectively. Mean utility and total annual costs were estimated at 0.772 and €20,600 at Expanded Disability Status Scale (EDSS) 0-3, 0.486 and €48,500 at EDSS 4-6.5 and 0.182 and €68,700 at EDSS 7-9, respectively. The mean cost of a relapse was €2050. CONCLUSION This study illustrates the burden of MS on Spanish patients and provides current data that are important for development of health policies.
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Affiliation(s)
- Celia Oreja-Guevara
- Department of Neurology, IdISSC, Hospital Universitario Clinico San Carlos, Madrid, Spain
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Péntek M, Kobelt G, Berg J, Capsa D, Dalén J, Bíró Z, Mátyás K, Komoly S. New insights into the burden and costs of multiple sclerosis in Europe: Results for Hungary. Mult Scler 2017. [DOI: 10.1177/1352458517708142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: To estimate the value of interventions in multiple sclerosis (MS) – where lifetime costs and outcomes cannot be observed – outcome data have to be combined with costs. This requires that cost data be regularly updated. Objectives and methods: This study is part of a cross-sectional retrospective study in 16 countries collecting data on resource consumption, work capacity, health-related quality of life (HRQoL) and prevalent symptoms for patients with MS. Descriptive analyses are presented by level of disability, from the societal perspective, in HUF 2015. Results: A total of 521 patients (mean age 47 years) participated; 85% were below retirement age, and of these, 47% were employed. Employment was related to disability and MS affected productivity at work for 82% of those working. Overall, 94% and 66% of patients experienced fatigue and cognitive difficulties as a problem, respectively. The mean utility and annual costs were 0.691 and 3,432,000HUF at Expanded Disability Status Scale (EDSS) 0–3, 0.491 and 5,262,000HUF at EDSS 4–6.5 and 0.076 and 6,235,000HUF at EDSS 7–9, respectively. The average cost of a relapse was estimated at 240,500HUF. Conclusion: This study illustrates the burden of MS on Hungarian patients and provides current data that are important for the development of health policies.
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Affiliation(s)
- Márta Péntek
- Corvinus University of Budapest, Budapest, Hungary
| | | | | | | | | | - Zita Bíró
- Flór Ferenc County Hospital, Kistarcsa, Hungary
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Havrdova E, Kobelt G, Berg J, Capsa D, Gannedahl M, Doležal T. New insights into the burden and costs of multiple sclerosis in Europe: Results of the Czech Republic. Mult Scler 2017. [DOI: 10.1177/1352458517708117] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: In order to estimate the value of interventions in multiple sclerosis (MS) – where lifetime costs and outcomes cannot be observed – outcome data have to be combined with costs. This requires that cost data be regularly updated. Objectives and methods: This study is part of a cross-sectional retrospective study in 16 countries collecting data on resource consumption and work capacity, health-related quality of life (HRQoL) and prevalent symptoms for patients with MS. Descriptive analyses are presented by level of severity, in the societal perspective, in CZK 2015. Results: A total of 747 patients (mean age 47 years) participated; 86% were below retirement age and of these, 49% were employed. Employment was related to disease severity, and MS affected productivity at work for 82% of those working. Overall, 92% and 66% of patients experienced fatigue and cognitive difficulties as a problem. Mean utility and annual costs were 0.832 and 257,000CZK at Expanded Disability Status Scale (EDSS) 0–3, 0.530 and 425,500CZK at EDSS 4–6.5 and 0.141 and 489,000CZK at EDSS 7–9. The average cost of a relapse was estimated at 12,600CZK. Conclusion: This study provides current data on MS in the Czech Republic that are important for the development of health policies.
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Affiliation(s)
- Eva Havrdova
- Department of Neurology, Charles University, Praha, Czech Republic
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Abstract
Background: To estimate the value of treatments in multiple sclerosis (MS) – where lifetime costs and outcomes cannot be observed – outcome data have to be combined with cost data. This, in turn, requires that cost data be regularly updated. Objectives and Methods: This study is part of a cross-sectional retrospective study in 16 countries collecting current data on resource consumption, work capacity, health-related quality of life (HRQoL) and prevalent symptoms for patients with MS. Descriptive analyses are presented by level of severity, from the societal perspective, in 2015 Danish Kronor (DKK). Results: A total of 830 patients (mean age of 54 years) participated; 78% were below retirement age and of these, 43% were employed. Employment was related to disease severity, and MS was felt to affect productivity at work by 73% of patients, most often through fatigue. Overall, 95% and 65% of patients felt that fatigue and cognition, respectively, were a problem. Mean utility and costs were 0.770 and 196,900DKK at Expanded Disability Status Scale (EDSS) 0–3, 0.619 and 287,300DKK at EDSS 4–6.5, and 0.302 and 533,250DKK at EDSS 7–9. The average cost of a relapse was estimated at 19,000DKK. Conclusion: This study illustrates the burden of MS on Danish patients and provides current data that are important for the development of health policies.
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Calabrese P, Kobelt G, Berg J, Capsa D, Eriksson J. New insights into the burden and costs of multiple sclerosis in Europe: Results for Switzerland. Mult Scler 2017. [DOI: 10.1177/1352458517708685] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: To estimate the value of interventions in multiple sclerosis (MS) – where lifetime costs and outcomes cannot be observed – outcome data have to be combined with costs. This requires that cost data be regularly updated. Objectives and methods: This study is part of a cross-sectional retrospective study in 16 countries collecting data on resource consumption and work capacity, health-related quality of life (HRQoL) and prevalent symptoms for patients with MS. Descriptive analyses are presented by level of severity, from the societal perspective, in CHF 2015. Results: A total of 721 patients (mean age 48 years) participated in Switzerland; 90% were below retirement age, and of these, 65% were employed. Employment was related to disease severity, and MS affected productivity at work for 69% of patients. Overall, 93% and 64% of patients experienced fatigue and cognition as a problem, respectively. The mean utility and annual costs were 0.799 and 29,600CHF at Expanded Disability Status Scale (EDSS) 0–3, 0.614 and 66,800CHF at EDSS 4–6.5 and 0.348 and 110,800CHF at EDSS 7–9, respectively. The mean cost of a relapse was estimated at 7600CHF. Conclusion: This study provides current data on MS in Switzerland that are important for development of health policies and to estimate the value of current and future treatments.
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Affiliation(s)
- Pasquale Calabrese
- Division of Molecular and Cognitive Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland
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Selmaj K, Kobelt G, Berg J, Orlewska E, Capsa D, Dalén J. New insights into the burden and costs of multiple sclerosis in Europe: Results for Poland. Mult Scler 2017. [DOI: 10.1177/1352458517708666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: In order to estimate the value of interventions in multiple sclerosis (MS) – where lifetime costs and outcomes cannot be observed – outcome data have to be combined with costs. This requires that cost data be regularly updated. Objective and methods: This study is part of a cross-sectional retrospective study in 16 European countries collecting current data on resource consumption, work capacity, health-related quality of life (HRQoL) and prevalent symptoms for patients with MS. Descriptive analyses are presented by level of severity, from the societal perspective, in 2015 Polish Zloty (PLN). Results: A total of 411 MS patients (mean age = 40 years) participated in Poland; 94% were below retirement age, and of these, 59% were employed. Employment was related to disability, and MS affected productivity for 85% of those working. Overall, 97% and 71% of patients experienced fatigue and cognition as important problems, respectively. Mean utility and total annual costs were 0.686 and 48,700 PLN at Expanded Disability Status Scale (EDSS) 0–3, 0.521 and 59,200 PLN at EDSS 4–6.5 and 0.208 and 81,600 PLN at EDSS 7–9, respectively. The average cost of a relapse was 3,900 PLN. Conclusion: This study illustrates the burden of MS on Polish patients and provides current data that are important for developing health policies.
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Affiliation(s)
| | | | | | - Ewa Orlewska
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
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Boyko A, Kobelt G, Berg J, Boyko O, Popova E, Capsa D, Eriksson J. New insights into the burden and costs of multiple sclerosis in Europe: Results for Russia. Mult Scler 2017. [DOI: 10.1177/1352458517708668] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: In order to assess the value of management strategies in multiple sclerosis (MS), outcome data have to be combined with cost data. This, in turn, requires that cost data be regularly updated. Objective and methods: This study is part of a cross-sectional retrospective study in 16 countries collecting current data on resource consumption, work capacity and health-related quality of life (HQoL). Descriptive analyses are presented by level of severity; costs are estimated in the societal perspective, in RUB 2015. Results: A total of 208 patients (mean age: 38.5 years) participated in the Russian study; 97% were below retirement age, and of these, 49% were employed. MS was reported to affect productivity at work in 63% of patients. Overall, 87% and 41% of patients felt that fatigue and cognition were a problem. The mean utility and costs were 0.769 and 578,000 RUB at Expanded Disability Status Scale (EDSS) 0–3, 0.509 and 826,000 RUB at EDSS 4–6.5, and 0.071 and 1,013,000 RUB at EDSS 7–9. The average cost of a relapse was 33,000 RUB. Conclusion: This study illustrates the burden of MS on Russian patients and provides current data that are important for developing health policies.
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Affiliation(s)
- Alexey Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | | | | | - Olga Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Ekaterina Popova
- Pirogov Russian National Research Medical University, Moscow, Russia
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Berger T, Kobelt G, Berg J, Capsa D, Gannedahl M. New insights into the burden and costs of multiple sclerosis in Europe: Results for Austria. Mult Scler 2017. [PMID: 28643599 DOI: 10.1177/1352458517708099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: In order to estimate the value of interventions in multiple sclerosis (MS) – where lifetime costs and outcomes cannot be observed – outcome data have to be combined with costs. This requires that cost data be regularly updated. Objectives and Methods: This study is part of a cross-sectional retrospective study in 16 countries collecting data on resource consumption and work capacity, health-related quality of life (HRQoL) and prevalent symptoms for patients with MS. Descriptive analyses are presented by level of severity, from the societal perspective, in EUR 2015. Results: A total of 516 patients (mean age, 53 years) participated in Austria; 72% were below retirement age, and of these, 46% were employed. Employment was related to disability, and MS affected productivity at work for 77% of those working. Overall, 94% and 67% of patients experienced fatigue and cognition as a problem. Mean utility and total annual costs were 0.778 and 25,100€ at Expanded Disability Status Scale (EDSS) 0–3, 0.579 and 44,100€ at EDSS 4–6.5, and 0.244 and 73,800€ at EDSS 7–9. The mean cost of a relapse was estimated at 2563€. Conclusion: This study illustrates the burden of MS on Austrian patients and provides current data on MS that are important for development of health policies.
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Affiliation(s)
- Thomas Berger
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Brundin L, Kobelt G, Berg J, Capsa D, Eriksson J. New insights into the burden and costs of multiple sclerosis in Europe: Results for Sweden. Mult Scler 2017. [DOI: 10.1177/1352458517708682] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: To assess the value of management strategies in multiple sclerosis (MS), outcome data have to be combined with cost data. This requires that cost data be regularly updated. Objective and methods: This study is part of a cross-sectional retrospective study in 16 countries collecting current data on resource consumption, work capacity and health-related quality of life (HRQoL). Descriptive analyses are presented by level of severity; costs are estimated in the societal perspective, in 2015 SEK. Results: A total of 1864 patients (mean age 56 years) participated in Sweden; 74% were below retirement age, and of these, 55% were employed. MS was reported to affect productivity at work in 78% of patients. Overall, 94% and 72% of patients felt that fatigue and cognition were a problem, respectively. The mean utility and costs were 0.757 and 244,000SEK at Expanded Disability Status Scale (EDSS) 0–3, 0.563 and 384,000SEK at EDSS 4–6.5 and 0.202 and 888,000SEK at EDSS 7–9, respectively. The average cost of a relapse was 36,900SEK. Conclusion: This study illustrates the burden of MS on Swedish patients and provides current data that are important for the development of health policies.
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Affiliation(s)
- Lou Brundin
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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