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Jia Y, Qiao X, Zhao J, Li H, Hu S, Hu M. Disease Burden and Costs Associated with Multiple Sclerosis in China: A Cross-sectional Analysis of Nationwide Survey Data. Neurosci Bull 2024; 40:533-538. [PMID: 37917312 PMCID: PMC11003946 DOI: 10.1007/s12264-023-01135-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/23/2023] [Indexed: 11/04/2023] Open
Affiliation(s)
- Yusheng Jia
- Department of Health Economics, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Xuanqi Qiao
- Department of Health Economics, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Jin Zhao
- Department of Health Economics, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Hainan Li
- Department of Health Economics, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Shanlian Hu
- Department of Health Economics, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Min Hu
- Department of Health Economics, School of Public Health, Fudan University, Shanghai, 200032, China.
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China.
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Lamba S, Jones KT, Grozdanic T, Moy E. Differences by Sexual Orientation in Patient-Centered Care Outcomes for Veterans Utilizing Primary Care Services at the Veterans Health Administration. LGBT Health 2024. [PMID: 38837356 DOI: 10.1089/lgbt.2023.0224] [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: 06/07/2024] Open
Abstract
Purpose: This study examined the differences by sexual orientation in patient-centered care outcomes (including health care experiences and health-related screening) of veterans utilizing Veterans Health Administration (VHA) primary care. Methods: VHA's adapted version of the Consumer Assessment of Healthcare Providers and Systems was used to compare the health care experience of primary care services among sexual minority (SM) and heterosexual veterans. Health care experience measures were dichotomized to "always" versus "less" and stratified by SM status. Health-related screening measures were dichotomous. Survey data were weighted using provided sample weights. Descriptive statistics were performed on sociodemographic characteristics. Logistic regression coefficients were represented as adjusted odds ratios (aORs). A total of 66,348 veterans were included in the analytic sample, of which 2.9% (n = 1,935) identified as SM. Sexual orientation was ascertained by self-report measures by veterans. Results: SM veterans were significantly younger (56.95 years vs. 63.43 years, p < 0.001), were less likely to report that their provider showed respect for what they had to say (aOR: 0.76; 95% confidence interval [CI]: 0.61-0.95), that they were asked about difficulties taking care of their health (aOR: 0.81; 95% CI: 0.67-0.96), and their provider listened carefully to them (aOR: 0.71; 95% CI: 0.57-0.87) compared to heterosexual veterans. Conclusion: Health care experiences differed between SM and heterosexual veterans who sought VHA primary care, suggesting the need to increase provider trainings, which may improve cultural competency and promote a more welcoming and inclusive environment.
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Affiliation(s)
- Shane Lamba
- VA Office of Health Equity, Veterans Health Administration, Washington, District of Columbia, USA
| | - Kenneth T Jones
- VA Office of Health Equity, Veterans Health Administration, Washington, District of Columbia, USA
| | - Tamara Grozdanic
- VA Office of Health Equity, Veterans Health Administration, Washington, District of Columbia, USA
| | - Ernest Moy
- VA Office of Health Equity, Veterans Health Administration, Washington, District of Columbia, USA
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Neto LO, Ruiz JA, Gromisch ES. Perceived health- related quality of life in persons with multiple sclerosis with and without a vascular comorbidity. Qual Life Res 2024; 33:573-581. [PMID: 37966685 DOI: 10.1007/s11136-023-03546-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE Vascular comorbidities are prevalent and can contribute to adverse health outcomes in persons with multiple sclerosis (PwMS). Understanding the association between vascular comorbidities and health-related quality of life (HRQOL) among PwMS may be beneficial in improving outcomes and disease management. This cross-sectional study aimed to examine the relationship between vascular comorbidities and the different dimensions of HRQOL in PwMS. METHODS Participants (n = 185) were PwMS recruited from a community-based comprehensive MS care center. Demographics, comorbid conditions, and disability level were collected via a self-report REDCap survey, with the 29-item Multiple Sclerosis Quality of Life (MSQOL-29) as the outcome measure. Regression models were used to examine the association between vascular comorbidities and the MSQOL-29, controlling for age, gender, ethnicity, level of education, marital status, MS subtype, disease duration, and disability. RESULTS Approximately 35% reported at least one vascular comorbidity, with the most common being hypertension (27.0%), followed by hyperlipidemia (24.9%) and diabetes (8.1%). After factoring in for demographics and disability, having a vascular comorbidity was associated with lower physical HRQOL (β = - 10.05, 95% CI: - 28.24, 23.50), but not mental HRQOL (β = - 2.61, 95% CI: - 10.54, 5.32). Hypertension was negatively associated with several dimensions of HRQOL, including Physical Function, Change in Health, Health Perceptions, Energy, and Health Distress. CONCLUSIONS Having at least one vascular comorbidity is associated with lower physical HRQOL, independent of demographics and level of physical disability. Focus should be directed to the physical burden and challenges vascular comorbidities may cause on the lives of PwMS.
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Affiliation(s)
- Lindsay O Neto
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, USA.
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at, Quinnipiac University, North Haven, CT, USA.
| | - Jennifer A Ruiz
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at, Quinnipiac University, North Haven, CT, USA
- Department of Medical Sciences, Frank H. Netter MD School of Medicine at, Quinnipiac University, North Haven, CT, USA
| | - Elizabeth S Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at, Quinnipiac University, North Haven, CT, USA
- Department of Medical Sciences, Frank H. Netter MD School of Medicine at, Quinnipiac University, North Haven, CT, USA
- Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA
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Schauf M, Chinthapatla H, Dimri S, Li E, Hartung DM. Economic burden of multiple sclerosis in the United States: A systematic literature review. J Manag Care Spec Pharm 2023; 29:1354-1368. [PMID: 37976077 PMCID: PMC10776266 DOI: 10.18553/jmcp.2023.23039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is chronic progressive disease that poses a significant economic burden to patients and health care systems in the United States. We conducted a systematic literature review to provide up-to-date insights on the economic burden of MS in the United States. OBJECTIVE To comprehensively review and summarize the latest published evidence on the economic burden of MS with a focus on cost, resource use, and work productivity. METHODS A systematic literature search was conducted using the Embase and Medline databases to identify studies, published between January 2011 and July 2022, reporting cost, resource use, or work productivity outcomes among people with MS in the United States. Clinical trials, economic modeling studies, and review articles were excluded. Details of eligible studies, including study design, patient population, and study outcomes for the overall population, as well as subgroups of interest, were extracted and summarized qualitatively. RESULTS Overall, 65 studies reporting cost, resource use, or work productivity data were included with majority of studies using claims data. The direct costs associated with MS ranged from $16,614 (2006) to $72,744 (2017) per patient per year with diseasemodifying therapies (DMTs) being the major cost contributors accounting for 43%-78%. The indirect costs reported ranged from $9,122 (2017) to $30,601 (2011) per patient per year with absenteeism, early retirement, and informal care being the key drivers for indirect costs. Costs, resource use, and work impairment were significantly higher for patients with severe disability compared with those with mild disability. Pharmacy costs were the major cost drivers in patients with mild, moderate, and severe disability. Similarly, patients with relapses incurred significantly higher costs, resource use, and work impairment compared with those without relapses. Additional hospitalization charges were the major driver of higher costs in patients who experienced relapses compared with those without relapses. CONCLUSIONS Direct costs, particularly DMTs, appear to be the major cost drivers for people with MS in the United States. Availability of lower-cost therapies may considerably decrease the economic burden on these patients and the health care systems. Future research focusing on indirect costs, intangible costs, and their contributors would contribute to further understanding of economic burden to avoid underestimation of the financial burden experienced by the patients.
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Affiliation(s)
| | | | - Seema Dimri
- Novartis Healthcare Pvt. Ltd., Hyderabad, India
- Sandoz Pvt. Ltd., Hyderabad, India
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5
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Brochet B, Solari A, Lechner-Scott J, Piehl F, Langdon D, Hupperts R, Selmaj K, Patti F, Brieva L, Maida EM, Alexandri N, Smyk A, Nolting A, Keller B, Montalban X, Kubala Havrdova E. Improvements in quality of life over 2 years with cladribine tablets in people with relapsing multiple sclerosis: The CLARIFY-MS study. Mult Scler 2023; 29:1808-1818. [PMID: 37978852 PMCID: PMC10687821 DOI: 10.1177/13524585231205962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) negatively affects health-related quality of life (HRQoL). OBJECTIVE To evaluate HRQoL in people with highly active relapsing MS treated with cladribine tablets (CladT; 3.5 mg/kg cumulative dose over 2 years) in CLARIFY-MS. METHODS Changes in the MS quality of life (MSQoL)-54 scores were analysed using a repeated mixed-effects linear model. Subgroup analyses were performed for participants who were pretreatment-naïve and those pretreated with disease-modifying therapies (DMTs) before initiating CladT. Safety and tolerability of CladT were also assessed. RESULTS MSQoL-54 physical (mean change = 4.86; 95% confidence interval (CI) = 3.18, 6.53) and mental health (4.80; 95% CI = 3.13, 6.46) composite scores (primary endpoints) showed significant improvement at Month 24 versus Baseline (p < 0.0001). Changes in the MSQoL-54 scores were consistent across the pretreatment-naïve and DMT-pretreated subgroups. No new severe or opportunistic infections occurred. Most post-baseline lymphopenia events were Grade 1-2 in severity. Transient Grade-3 lymphopenia was observed in 19.7% (95/482) of participants. Grade-4 lymphopenia was not observed. CONCLUSIONS CladT treatment significantly improved the mean MSQoL-54 physical and mental health composite scores over 2 years. CladT efficacy in HRQoL, relapse rates and Expanded Disability Status Scale scores demonstrates its multidimensional effects in MS treatment.
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Affiliation(s)
- Bruno Brochet
- INSERM U 1215, University of Bordeaux, Bordeaux, France
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Jeannette Lechner-Scott
- University of Newcastle, Newcastle, NSW, Australia/Division of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Dawn Langdon
- Department of Psychology, Royal Holloway, University of London, Egham, UK
| | - Raymond Hupperts
- Zuyderland Medisch Centrum Sittard, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, and Azienda Ospedaliero Universitaria Policlinico “G. Rodolico” – San Marco, University of Catania, Italy
| | - Luis Brieva
- IRBlLeida, Hospital Arnau de Vilanova, Lérida, Spain
| | | | | | | | | | | | - Xavier Montalban
- Department of Neurology-Neuroimmunology Centre of Multiple Sclerosis of Catalonia (Cemcat), University Hospital Vall d’Hebron, Barcelona, Spain
| | - Eva Kubala Havrdova
- Department of Neurology and Center for Clinical Neuroscience, First Medical Faculty, Charles University, Prague, Czech Republic
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Cozart JS, Bruce AS, Shook RP, Befort C, Siengsukon C, Simon S, Lynch SG, Mahmoud R, Drees B, Posson P, Hibbing PR, Huebner J, Bradish T, Robichaud J, Bruce JM. Body metrics are associated with clinical, free-living, and self-report measures of mobility in a cohort of adults with obesity and multiple sclerosis. Mult Scler Relat Disord 2023; 79:105010. [PMID: 37776827 DOI: 10.1016/j.msard.2023.105010] [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: 04/25/2023] [Revised: 08/29/2023] [Accepted: 09/13/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Obesity is associated with multiple sclerosis (MS) onset and may contribute to more rapid disability accumulation. Whether obesity impacts mobility in MS is uncertain. Some studies find that obesity in MS is associated with poorer mobility; other studies find no relationship. Discrepant findings may be due to differences in measurement and methodology. In the present study, we employ a comprehensive battery of anthropometric and mobility measures in a sample of people with MS and obesity. METHODS Participants with MS (N = 74) completed a battery of adiposity measurements (weight, height, waist circumference, and full body dual-energy x-ray absorptiometry [DXA] scans). They also completed validated clinical, free-living (accelerometry), and self-report measures of mobility. Spearman's Rho correlations were used to examine the associations between mobility and obesity measures with Benjamini and Hochberg correction for multiple comparisons. Multiple linear regression was used to examine if adiposity predicted mobility outcomes in people with MS when controlling for age and disease duration. RESULTS The majority of participants (n = 70) were diagnosed with relapsing-remitting MS and reported mild MS-related disability on the Patient Determined Disease Steps (M = 0.77, SD = 1.1). Median BMI was 35.8 (SD = 5.4). Higher percentage body fat (measured via DXA) was associated with poorer self-reported physical functioning (rs = -0.52, p <0.001), less moderate-to-vigorous physical activity (rs = -0.24, p = 0.04), and worse performance on the Six Minute Walk Test (6MWT; rs = -0.44, p <0.001), the Timed 25 Foot Walk (T25FW; rs = 0.45, p <0.001), and the Timed Up and Go test (TUG; rs = 0.35, p = .003). Higher BMI and waist-to-height ratio (WtHR) were associated with worse outcomes on the 6MWT (BMI; rs = -0.35, p <0.01, WtHR; rs = -0.43, p <0.001), T25FW (BMI; rs = 0.32, p <0.01, WtHR; rs = 0.38, p <0.001), and the SF-36 (BMI; rs = -0.29, p <0.005, WtHR; rs = -0.31, p <0.05). Percentage body fat accounted for an additional 17 % of the variance in the T25FW and 6MWT performance, after controlling for age and disease duration. CONCLUSION Higher BMI, WtHR, and percentage body fat were associated with lower levels of mobility (T25FW and 6MWT) in people with MS who have class I, class II, and class III obesity. Higher percentage body fat was associated with significantly worse performance on clinical, free-living, and self-report measures of mobility in people with MS even when accounting for participant age and disease duration. These findings suggest that people with MS and obesity may show improved mobility with weight loss.
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Affiliation(s)
- J S Cozart
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA; Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri, USA.
| | - A S Bruce
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, Missouri, USA; Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - R P Shook
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, Missouri, USA; Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA; School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri USA
| | - C Befort
- Department of Population Health, University Kansas Medical Center, Kansas City, Kansas, USA
| | - C Siengsukon
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - S Simon
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
| | - S G Lynch
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - R Mahmoud
- Department of Neurology, Saint Luke's Hospital, Kansas City, Missouri, USA; Department of Neurology, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - B Drees
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA; Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA; Graduate School of the Stowers Institute for Medical Research, Kansas City, Missouri, USA
| | - P Posson
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - P R Hibbing
- Department of Kinesiology & Nutrition, University of Illinois Chicago, Chicago, Illinois, USA
| | - J Huebner
- Department of Community and Family Medicine University Health Lakewood Medical Center, Medicine, Kansas City, Missouri, USA
| | - T Bradish
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
| | - J Robichaud
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
| | - J M Bruce
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA; Departments of Neurology and Psychiatry, University Health, Kansas City, Missouri, USA
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Geiger CK, Sheinson D, To TM, Jones D, Bonine NG. Real-World Clinical and Economic Outcomes Among Persons With Multiple Sclerosis Initiating First- Versus Second- or Later-Line Treatment With Ocrelizumab. Neurol Ther 2023; 12:1709-1728. [PMID: 37458897 PMCID: PMC10444704 DOI: 10.1007/s40120-023-00523-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/29/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION Prior research has demonstrated that early treatment with high-efficacy disease-modifying therapies (DMTs), including ocrelizumab (OCR), can reduce relapses and delay disease progression among persons with multiple sclerosis (pwMS) compared with escalation from low-/moderate-efficacy DMTs. However, there is a lack of research examining the impact of early use of OCR on real-world clinical and economic outcomes. This study aimed to evaluate differences in events often associated with a relapse (EOAR) as well as non-DMT healthcare resource use (HCRU) and costs among pwMS who received OCR as a first-line treatment compared with later-line treatment after diagnosis. METHODS Newly diagnosed adult pwMS were selected from deidentified Optum Market Clarity claims data (study period: January 1, 2015-June 30, 2021). All pwMS were required to have initiated OCR after diagnosis and have 12 months of continuous eligibility prior to diagnosis. The index date was the date of initiation of the first-line DMT after diagnosis. pwMS who initiated OCR as first-line (1L OCR cohort) or a second- or later-line treatment (2L + OCR cohort) were matched 1:1 based on length of continuous eligibility after the first-line DMT and weighted using stabilized inverse probability of treatment. In the follow-up period, differences in outcomes, including annualized EOAR, non-DMT HCRU and costs, were evaluated for pwMS in the 1L vs. 2L + OCR cohorts. RESULTS The sample included 748 pwMS. During the follow-up period, pwMS in the 1L OCR cohort had a significantly lower annual rate of EOAR compared with pwMS in the 2L + OCR cohort (0.37 vs. 0.56; difference: 0.20 [95% CI 0.08, 0.32]). pwMS in the 1L OCR cohort had a significantly lower probability of any hospitalization within 1 year, fewer non-DMT outpatient visits and lower all-cause and MS-related, non-DMT costs compared with pwMS in the 2L + OCR cohort. CONCLUSIONS First-line initiation OCR was associated with improvements in clinical and non-DMT economic outcomes compared with later-line initiation of OCR, suggesting that early initiation may benefit both patients and the healthcare system.
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Affiliation(s)
| | - Danny Sheinson
- Genentech, Inc., 350 DNA Way, South San Francisco, CA, 94080, USA
| | - Tu My To
- Genentech, Inc., 350 DNA Way, South San Francisco, CA, 94080, USA
| | - David Jones
- Genentech, Inc., 350 DNA Way, South San Francisco, CA, 94080, USA
| | - Nicole G Bonine
- Genentech, Inc., 350 DNA Way, South San Francisco, CA, 94080, USA
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Lamba S, Obedin-Maliver J, Mayo J, Flentje A, Lubensky ME, Dastur Z, Lunn MR. Self-Reported Barriers to Care Among Sexual and Gender Minority People With Disabilities: Findings From The PRIDE Study, 2019-2020. Am J Public Health 2023; 113:1009-1018. [PMID: 37471680 PMCID: PMC10413745 DOI: 10.2105/ajph.2023.307333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 07/22/2023]
Abstract
Objectives. To examine the associations of self-reported disability status with health care access barriers for sexual and gender minority (SGM) people. Methods. The Population Research in Identity and Disparities for Equality (PRIDE) Study participants lived in the United States or its territories, completed the 2019 annual questionnaire (n = 4961), and self-reported their disability and health care access experiences, including whether they had a primary care provider, were uninsured, delayed care, and were unable to obtain care. We classified disabilities as physical, mental, intellectual, and other; compared participants to those without disabilities; and performed logistic regression to determine the associations of disability status and health care access barriers. Results. SGM people with disabilities were less likely to have a usual place to seek health care (69.0% vs 75.3%; P ≤ .001) and more often reported being mistreated or disrespected as reasons to delay care (29.0% vs 10.2%; P ≤ .001). SGM people with disabilities were more likely to delay care (adjusted odds ratio [AOR] = 3.28; 95% confidence interval [CI] = 2.83, 3.81) and be unable to obtain care (AOR = 3.10; 95% CI = 2.59, 3.71). Conclusions. Future work should address culturally competent health care to ameliorate disparities for the SGM disability community. (Am J Public Health. 2023;113(9):1009-1018. https://doi.org/10.2105/AJPH.2023.307333).
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Affiliation(s)
- Shane Lamba
- Shane Lamba, Juno Obedin-Maliver, Annesa Flentje, Micah E. Lubensky, Zubin Dastur, and Mitchell R. Lunn are with The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA. Jonathan Mayo is with the Dunlevie Maternal-Fetal Medicine Center, Stanford University School of Medicine
| | - Juno Obedin-Maliver
- Shane Lamba, Juno Obedin-Maliver, Annesa Flentje, Micah E. Lubensky, Zubin Dastur, and Mitchell R. Lunn are with The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA. Jonathan Mayo is with the Dunlevie Maternal-Fetal Medicine Center, Stanford University School of Medicine
| | - Jonathan Mayo
- Shane Lamba, Juno Obedin-Maliver, Annesa Flentje, Micah E. Lubensky, Zubin Dastur, and Mitchell R. Lunn are with The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA. Jonathan Mayo is with the Dunlevie Maternal-Fetal Medicine Center, Stanford University School of Medicine
| | - Annesa Flentje
- Shane Lamba, Juno Obedin-Maliver, Annesa Flentje, Micah E. Lubensky, Zubin Dastur, and Mitchell R. Lunn are with The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA. Jonathan Mayo is with the Dunlevie Maternal-Fetal Medicine Center, Stanford University School of Medicine
| | - Micah E Lubensky
- Shane Lamba, Juno Obedin-Maliver, Annesa Flentje, Micah E. Lubensky, Zubin Dastur, and Mitchell R. Lunn are with The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA. Jonathan Mayo is with the Dunlevie Maternal-Fetal Medicine Center, Stanford University School of Medicine
| | - Zubin Dastur
- Shane Lamba, Juno Obedin-Maliver, Annesa Flentje, Micah E. Lubensky, Zubin Dastur, and Mitchell R. Lunn are with The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA. Jonathan Mayo is with the Dunlevie Maternal-Fetal Medicine Center, Stanford University School of Medicine
| | - Mitchell R Lunn
- Shane Lamba, Juno Obedin-Maliver, Annesa Flentje, Micah E. Lubensky, Zubin Dastur, and Mitchell R. Lunn are with The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA. Jonathan Mayo is with the Dunlevie Maternal-Fetal Medicine Center, Stanford University School of Medicine
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Vitturi BK, Rahmani A, Dini G, Montecucco A, Debarbieri N, Bandiera P, Ponzio M, Battaglia MA, Brichetto G, Inglese M, Persechino B, Durando P. Work Barriers and Job Adjustments of People with Multiple Sclerosis: A Systematic Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:450-462. [PMID: 36399281 DOI: 10.1007/s10926-022-10084-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
Purpose The aim was to carry out a systematic review dedicated to describing the work barriers and the job adjustments that are particularly sensitive to people with Multiple Sclerosis (PwMS). Methods Four electronic databases (PubMed/MEDLINE, Scopus, SciVerse ScienceDirect, and Web of Science) were searched for peer-reviewed original articles reporting the barriers at work and/or the job adjustments used by PwMS. MS must have been diagnosed according to accepted international criteria at the time of the study and/or confirmed by a doctor. No time limits were set for the search. Articles that were published in English, Italian, Spanish, French, and Portuguese were accepted. Each article was screened by three experienced and trained investigators. The protocol was registered in PROSPERO (CRD42022299994). Results The initial systematic search yielded 104,228 results, of which 49 articles provided sufficient information and were considered suitable for inclusion in the study. Overall, the studies included 30283 participants with MS. Thirteen (27.1%) studies reported on barriers to work, 14 (29.2%) addressed reasonable adjustments and 21 (43.7%) assessed both outcomes. Job characteristics are the most important barriers for PwMS. Other reported barriers concern the work environment, social relationships at work, negative work events and lack of information. PwMS are more vulnerable to the need for adjustments at the workplace, being the management of the workload the most commonly used one. Conclusions PwMS are exposed to a wide variety of work barriers and job adjustments. Future studies are still highly encouraged on the topic.
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Affiliation(s)
- Bruno Kusznir Vitturi
- Department of Health Sciences, University of Genoa, Building 3, L.Go R. Benzi, 10-16132, Genoa, Italy.
| | - Alborz Rahmani
- Department of Health Sciences, University of Genoa, Building 3, L.Go R. Benzi, 10-16132, Genoa, Italy
| | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, Building 3, L.Go R. Benzi, 10-16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Alfredo Montecucco
- Department of Health Sciences, University of Genoa, Building 3, L.Go R. Benzi, 10-16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Nicoletta Debarbieri
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Paolo Bandiera
- Italian Multiple Sclerosis Association (AISM), Genoa, Italy
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- Department of Life Sciences, University of Siena, Siena, Italy
| | | | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Neurology Unit, Genoa, Italy
| | | | - Paolo Durando
- Department of Health Sciences, University of Genoa, Building 3, L.Go R. Benzi, 10-16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
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10
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Dillon P, Heer Y, Karamasioti E, Muros-Le Rouzic E, Marcelli G, Di Maio D, Braune S, Kobelt G, Wasem J. The socioeconomic impact of disability progression in multiple sclerosis: A retrospective cohort study of the German NeuroTransData (NTD) registry. Mult Scler J Exp Transl Clin 2023; 9:20552173231187810. [PMID: 37529629 PMCID: PMC10387702 DOI: 10.1177/20552173231187810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/28/2023] [Indexed: 08/03/2023] Open
Abstract
Background Multiple sclerosis (MS) is a progressively debilitating neurologic disease that poses significant costs to the healthcare system and workforce. Objective To evaluate the impact of MS disease progression on societal costs and quality of life (QoL) using data from the German NeuroTransData (NTD) MS registry. Methods Cross-sectional cohort study. The cost cohort included patients with MS disability assessed using Expanded Disability Status Scale (EDSS) in 2019 while the QoL cohort included patients assessed using EDSS and EuroQol-5 Dimension 5-Levels between 2009 and 2019. Direct and indirect medical, and non-medical resource use was quantified and costs derived from public sources. Results Within the QoL cohort (n = 9821), QoL worsened with increasing EDSS. Within the cost cohort (n = 7286), increasing resource use with increasing EDSS was observed. Societal costs per patient, excluding or including disease-modifying therapies, increased from €5694 or €19,315 at EDSS 0 to 3.5 to €25,419 or €36,499 at EDSS 4 to 6.5, and €52,883 or €58,576 at EDSS 7 to 9.5. In multivariate modeling, each 0.5-step increase in EDSS was significantly associated with increasing costs, and worsening QoL. Conclusion This study confirms the major socioeconomic burden associated with MS disability progression. From a socioeconomic perspective, delaying disability progression may benefit patients and society.
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Affiliation(s)
| | - Yanic Heer
- PricewaterhouseCoopers (PwC), Zurich, Switzerland
| | | | | | | | | | - Stefan Braune
- NeuroTransData (NTD) GmbH, Neuburg an der Donau, Germany
| | - Gisela Kobelt
- EHE International GmbH, St Moritz, Switzerland
- European Health Economics, Mulhouse, France
| | - Jürgen Wasem
- Faculty of Economics, University of Duisburg-Essen, Essen, Germany
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Kontaxis S, Laporta E, Garcia E, Martinis M, Leocani L, Roselli L, Buron MD, Guerrero AI, Zabala A, Cummins N, Vairavan S, Hotopf M, Dobson RJB, Narayan VA, La Porta ML, Costa GD, Magyari M, Sørensen PS, Nos C, Bailon R, Comi G. Automatic Assessment of the 2-Minute Walk Distance for Remote Monitoring of People with Multiple Sclerosis. SENSORS (BASEL, SWITZERLAND) 2023; 23:6017. [PMID: 37447866 DOI: 10.3390/s23136017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/29/2023] [Accepted: 06/10/2023] [Indexed: 07/15/2023]
Abstract
The aim of this study was to investigate the feasibility of automatically assessing the 2-Minute Walk Distance (2MWD) for monitoring people with multiple sclerosis (pwMS). For 154 pwMS, MS-related clinical outcomes as well as the 2MWDs as evaluated by clinicians and derived from accelerometer data were collected from a total of 323 periodic clinical visits. Accelerometer data from a wearable device during 100 home-based 2MWD assessments were also acquired. The error in estimating the 2MWD was validated for walk tests performed at hospital, and then the correlation (r) between clinical outcomes and home-based 2MWD assessments was evaluated. Robust performance in estimating the 2MWD from the wearable device was obtained, yielding an error of less than 10% in about two-thirds of clinical visits. Correlation analysis showed that there is a strong association between the actual and the estimated 2MWD obtained either at hospital (r = 0.71) or at home (r = 0.58). Furthermore, the estimated 2MWD exhibits moderate-to-strong correlation with various MS-related clinical outcomes, including disability and fatigue severity scores. Automatic assessment of the 2MWD in pwMS is feasible with the usage of a consumer-friendly wearable device in clinical and non-clinical settings. Wearable devices can also enhance the assessment of MS-related clinical outcomes.
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Affiliation(s)
- Spyridon Kontaxis
- Laboratory of Biomedical Signal Interpretation and Computational Simulation (BSICoS), University of Zaragoza, 50018 Zaragoza, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28006 Barcelona, Spain
| | - Estela Laporta
- Laboratory of Biomedical Signal Interpretation and Computational Simulation (BSICoS), University of Zaragoza, 50018 Zaragoza, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28006 Barcelona, Spain
| | - Esther Garcia
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28006 Barcelona, Spain
- Department of Microelectronics and Electronic Systems, Autonomous University of Barcelona, 08193 Bellaterra, Spain
| | - Matteo Martinis
- Department of Medicine and Surgery, University Vita-Salute and Hospital San Raffaele, 20132 Milan, Italy
| | - Letizia Leocani
- Department of Medicine and Surgery, University Vita-Salute and Hospital San Raffaele, 20132 Milan, Italy
| | - Lucia Roselli
- Department of Medicine and Surgery, University Vita-Salute and Hospital San Raffaele, 20132 Milan, Italy
| | - Mathias Due Buron
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Ana Isabel Guerrero
- Multiple Sclerosis Center of Catalonia (CEMCAT), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Ana Zabala
- Multiple Sclerosis Center of Catalonia (CEMCAT), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Nicholas Cummins
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | | | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Richard J B Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | | | - Maria Libera La Porta
- Department of Medicine and Surgery, University Vita-Salute and Hospital San Raffaele, 20132 Milan, Italy
| | - Gloria Dalla Costa
- Department of Medicine and Surgery, University Vita-Salute and Hospital San Raffaele, 20132 Milan, Italy
| | - Melinda Magyari
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Per Soelberg Sørensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Carlos Nos
- Multiple Sclerosis Center of Catalonia (CEMCAT), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Raquel Bailon
- Laboratory of Biomedical Signal Interpretation and Computational Simulation (BSICoS), University of Zaragoza, 50018 Zaragoza, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28006 Barcelona, Spain
| | - Giancarlo Comi
- Department of Medicine and Surgery, University Vita-Salute and Hospital San Raffaele, 20132 Milan, Italy
- Casa di Cura del Policlinico, 20144 Milan, Italy
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Oliver S, Douglas J, Winkler D, Pearce C, Minter E, Jarman HK, Topping M. The healthcare needs and general practice utilization of people with acquired neurological disability and complex needs: A scoping review. Health Expect 2022; 25:2726-2745. [PMID: 36322481 PMCID: PMC9700155 DOI: 10.1111/hex.13640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/13/2022] [Accepted: 10/16/2022] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND For people with acquired neurological disabilities and complex needs, general practitioners (GPs) play an important role in health management and early intervention for the prevention of comorbidities and health complications. People with disability are a vulnerable group who need and have the right to, quality general practice services. It is therefore important to understand the health needs and service use of this group. The aim of this review was to identify the healthcare needs and general practice utilization of people with acquired neurological disabilities and complex needs. METHODS A scoping review methodological framework was utilized. Six databases (MEDLINE, PsycInfo, CINAHL, Scopus, Embase and the Cochrane Library) were searched. Articles were included if they reported on general practice service utilization of people with acquired neurological disabilities and complex needs aged between 18 and 65. Articles were required to be peer-reviewed, written in English and published between 2010 and 2021. RESULTS Thirty-one articles were included in the review. Studies originated from Canada (9), the United States (8), Australia (4), Switzerland (4), the United Kingdom (2), England (1), Norway (1), France (1) and Denmark (1). For many people, GPs were the main healthcare provider. People with disability consult multiple healthcare providers and navigate complex healthcare systems. Commonly presented healthcare needs were bladder, bowel and skin problems, pain and chronic pain, medication needs and mental health concerns. CONCLUSIONS People with acquired neurological disabilities and complex needs were vulnerable to receiving suboptimal healthcare. The literature highlighted issues regarding the accessibility of services, the fragmentation of health services and inadequate preventative care. GPs were challenged to offer adequate disability-related expertise and to meet the mental health needs of people with disability within time constraints. PATIENT AND PUBLIC INVOLVEMENT This manuscript was prepared in collaboration with a GP, who is one of the authors. A person with lived experience of acquired neurological disability was engaged to check the alignment of the findings with their personal experience and provide feedback.
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Affiliation(s)
- Stacey Oliver
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Jacinta Douglas
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Dianne Winkler
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | | | - Ella‐Rose Minter
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Hannah K. Jarman
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
| | - Megan Topping
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
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13
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Vitturi BK, Rahmani A, Dini G, Montecucco A, Debarbieri N, Bandiera P, Battaglia MA, Manacorda T, Persechino B, Buresti G, Ponzio M, Inglese M, Durando P. Spatial and temporal distribution of the prevalence of unemployment and early retirement in people with multiple sclerosis: A systematic review with meta-analysis. PLoS One 2022; 17:e0272156. [PMID: 35901070 PMCID: PMC9333213 DOI: 10.1371/journal.pone.0272156] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background We aimed to summarise the prevalence of unemployment and early retirement among people with MS and analyze data according to a spatio-temporal perspective. Methods We undertook a systematic search of PubMed/MEDLINE, Scopus, SciVerse ScienceDirect, and Web of Science. We included any peer-reviewed original article reporting the prevalence of unemployment and early retirement in the working-age population with MS. We excluded articles off-topic, with other study designs, whose study sample were unlikely to be representative of the MS population and in case of unavailability of the full text or essential information. A random-effects meta-analysis was used to measure overall prevalence estimates of unemployment and early retirement. We used meta-regression and subgroup analysis to evaluate potential moderators of prevalence estimates and the leave-one-out method for sensitivity analyses. Results Our research identified 153 studies across 29 countries encompassing 188436 subjects with MS. The pooled overall effect size for unemployment and early retirement was 35.6% (95% CI 32.8–38.4; I2 = 99.31) and 17.2% (95% CI 14.6–20.2; I2 = 99.13), respectively. The prevalence of unemployment varied according to the year of publication (p < 0.001) and there was a statistically significant decrease in the prevalence of unemployment over time (p = 0.042). Regarding early retirement, only seven (31.8%) estimates obtained from studies that were published before 2010 were below the overall effect size in comparison to 27 (60.0%) estimates extracted from data published between 2010 and 2021 (p = 0.039). There was a significant difference in prevalence according to countries (p < 0.001). Psychiatric illness was an important clinical feature responsible for patients leaving the workforce in regions with a high MS prevalence. Conclusions Unemployment and early retirement due to MS remain highly prevalent, despite a slight decline in the last decade. The prevalence of unemployment and early retirement varies globally.
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Affiliation(s)
| | - Alborz Rahmani
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Alfredo Montecucco
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Nicoletta Debarbieri
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Paolo Bandiera
- Italian Multiple Sclerosis Association (AISM), Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- Department of Life Science, University of Siena, Siena, Italy
| | - Tommaso Manacorda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | | | | | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
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14
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Health-related quality of life of patients with multiple sclerosis: Analysis of ten years of national data. Mult Scler Relat Disord 2022; 66:104019. [PMID: 35839614 DOI: 10.1016/j.msard.2022.104019] [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: 03/22/2022] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a progressive autoimmune disease of the central nervous system. Both the physical and mental burden of MS affect patients' health-related quality of life (HRQoL). However, there is limited research at the national level evaluating the humanistic burden among MS patients. OBJECTIVES This study evaluated the HRQoL and functional limitations among MS patients using ten years of national survey data. METHODS Guided by the conceptual framework of the Wilson and Cleary model, this study compared HRQoL between adults diagnosed with MS (Clinical Classification Code= "080″) and non-MS adults using the 2006-2015 Medical Expenditure Panel Survey (MEPS) data. The humanistic burden included HRQoL and functional limitations. The HRQoL was evaluated using physical component summary (PCS) and mental component summary (MCS) based on the Short Form Health Survey (SF-12). The study applied the multivariable Generalized Linear Models (GLM) to estimate the marginal differences in PCS and MCS based on the SF-12. In addition, seeking help for activities of daily living (ADL) and instrumental activities of daily living (IADL) were modeled with multivariable logistic regression. RESULTS According to the MEPS, the estimated annual prevalence of MS was 0.52 million (95% Confidence Interval [CI]: 0.42-0.60). MS patients were mainly female (71.90%), middle aged (50-64 years, 40.21%), non-Hispanic whites (78.29%), and enrolled in private insurance plans (68.93%). The average PCS scores in MS and non-MS groups were 35.70 and 49.48, respectively. The average MCS scores were 45.58 and 51.25 for MS and non-MS groups, respectively. In addition, 18.26% of MS patients sought help for ADL, and 27.08% sought help for IADL. After adjusting for individual, biological, and environmental characteristics, the multivariable GLM with Poisson distribution indicated that the marginal difference of PCS score was 11.10 (95% CI: 9.50-12.61) units lower, and the MCS score was 4.89 (95% CI: 3.44-6.30) units lower among MS patients. In addition, MS patients were 17.32 (95% CI: 11.61-25.84) and 14.43 (95% CI: 10.09-20.65) times more likely to request assistance for ADL and IADL, respectively. CONCLUSIONS MS was associated with lower physical and mental HRQoL than their non-MS counterparts and MS patients were more likely to request help for ADL and IADL. More work is needed to evaluate the effect of treatment strategies on improving the HRQoL and functional limitations in MS.
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Shahi SK, Yadav M, Ghimire S, Mangalam AK. Role of the gut microbiome in multiple sclerosis: From etiology to therapeutics. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 167:185-215. [PMID: 36427955 DOI: 10.1016/bs.irn.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease of the CNS that affects around one million people in the United States. Predisposition or protection from this disease is linked with both genetic and environmental factors. In recent years, gut microbiome has emerged as an important environmental factor in the pathobiology of MS. The gut microbiome supports various physiologic functions, including the development and maintenance of the host immune system, the perturbation of which is known as dysbiosis and has been linked with multiple diseases including MS. We and others have shown that people with MS (PwMS) have gut dysbiosis that is characterized by specific gut bacteria being enriched or depleted. Consequently, there is an emphasis on determining the mechanism(s) through which gut bacteria and/or their metabolites alter the course of MS through their ability to provide protection, predispose individuals, or promote disease progression. Improving our understanding of these mechanisms will allow us to harness the enormous potential of the gut microbiome as a diagnostic and/or therapeutic agent. In this chapter, we will discuss current advances in microbiome research in the context of MS, including a review of specific bacteria that are currently linked with this disease, potential mechanisms of disease pathogenesis, and the utility of microbiome-based therapy for PwMS.
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Affiliation(s)
- Shailesh K Shahi
- Department of Pathology, University of Iowa, Iowa City, IA, United States; Iowa City VA Health System, Iowa City, IA, United States
| | - Meeta Yadav
- Department of Pathology, University of Iowa, Iowa City, IA, United States; Iowa City VA Health System, Iowa City, IA, United States
| | - Sudeep Ghimire
- Department of Pathology, University of Iowa, Iowa City, IA, United States; Iowa City VA Health System, Iowa City, IA, United States
| | - Ashutosh K Mangalam
- Department of Pathology, University of Iowa, Iowa City, IA, United States; Iowa City VA Health System, Iowa City, IA, United States.
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Medicalization of Exercise Through Vigilance, Productivity, and Self-Care: A Secondary Data Analysis of Qualitative Interviews Among Those With Multiple Sclerosis. Adapt Phys Activ Q 2022; 39:399-423. [PMID: 35472758 DOI: 10.1123/apaq.2021-0200] [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: 11/09/2021] [Revised: 02/17/2022] [Accepted: 03/21/2022] [Indexed: 11/18/2022] Open
Abstract
Exercise is becoming more integrated into the management of multiple sclerosis (MS) and is promoted to manage impairments and symptoms. Whereas extensive research outlines factors impacting participation, less is known regarding how medicalized exercise promotion might impact views of exercise and self. We conducted a secondary data analysis to understand how medicalized exercise-promotion paradigms impact the meaning and roles of exercise among those with MS. Twenty-two interviews were selected for reanalysis with an interpretative phenomenological analysis methodology and a critical disability studies lens. Three themes were identified: Constant Vigilance (worry about exercise), Productivity and Social Engagement (exercise to feel productive, engage socially, and enhance self-worth), and Exercise as Medicine/Self-Care (exercise to manage MS, relax, improve mental well-being, prevent/reverse disability, and stay healthy). This research underscores that exercise occupies many contradictory roles reflecting a medicalized exercise-promotion paradigm for those with MS, and this should inform exercise promotion practices.
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17
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The disruptive radiologist. Clin Imaging 2022; 87:5-10. [DOI: 10.1016/j.clinimag.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/23/2022]
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Comorbidities as Predictors of All-Cause Emergency Department Utilization among Veterans with Multiple Sclerosis. Mult Scler Relat Disord 2022; 62:103806. [DOI: 10.1016/j.msard.2022.103806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/11/2022] [Accepted: 04/11/2022] [Indexed: 11/21/2022]
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Activity limitations and participation restrictions among people with non-communicable diseases in Ghana. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Anecdotal evidence suggests that non-communicable diseases (NCDs) contribute substantially to mortality, morbidity and disability in Ghana. Nonetheless, no data are presently available on Ghanaians with disability from major NCDs, such as hypertension, diabetes and stroke. Using data from the 2007/2008 Ghana World Health Organization Study on Global Ageing and Adult Health (SAGE) and applying ordinary least squares techniques, the prevalence of and associations between activity limitations and participation restrictions in Ghanaians with NCDs are examined in the present study. The results show stroke is the major contributor to activity limitations and participation restrictions among the Ghanaian population with NCDs. The study results further revealed that respondents with higher education reported high levels of disability compared to those with no education. The results suggest that functioning can be restored by providing assistive technologies, such as wheelchairs, prosthetic limbs, walking aids, etc., that can enhance participation of persons with disability in society.
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Rezaee M, Morowvat MH, Poursadeghfard M, Radgoudarzi A, Keshavarz K. Cost-effectiveness analysis of rituximab versus natalizumab in patients with relapsing remitting multiple sclerosis. BMC Health Serv Res 2022; 22:118. [PMID: 35090438 PMCID: PMC8796500 DOI: 10.1186/s12913-022-07495-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Multiple sclerosis (MS) is an inflammatory disease in which the myelin sheaths of the nerve cells in the brain and spinal cord, which are responsible for communication, are destroyed and cause physical signs and symptoms. According to studies, anti-CD20 monoclonal antibodies have significant results in the treatment of this disease. Thus, the aim of the present study was to determine the cost-effectiveness of rituximab against natalizumab in the patients with RRMS in southern Iran in 2020. Methods This is an economic evaluation including cost-effectiveness analysis in which the Markov model with a lifetime horizon was used. The study sample consisted of 120 patients randomly selected from among those referred to the MS Association and the Special Diseases Unit of Shiraz University of Medical Sciences. In this study, the costs were collected from a societal perspective, and the outcomes were obtained in the form of Quality Adjusted Life Years (QALY) and the mean relapse rate. The TreeAge pro 2020 and Excel 2016 software were used for data analysis. Results The comparative study of rituximab and natalizumab showed that the patients receiving rituximab had lower costs ($ 58,307.93 vs. $ 354,174.85) and more QALYs (7.77 vs. 7.65). In addition, the incidence of relapse by rituximab was lower compared to natalizumab (1.15 vs. 2.57). The probabilistic one-way sensitivity analysis showed the robustness of the results. The scatter plots also showed that rituximab was more cost-effective for the patients in 100% of the simulations for the threshold of < $ 37,641. Discussion and conclusion According to the results of this study, rituximab had higher cost-effectiveness than natalizumab. Therefore, it could be a priority for RRMS patients compared to natalizumab because it reduced treatment costs and increased effectiveness.
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Miller DM, Cofield SS, Planchon SM, Givens SE, Salter A, Schmidt HK, Corlette S, Musil CC. Assessing Access to Five Types of Insurance by People with Multiple Sclerosis Using a Cross-sectional Online Survey. Int J MS Care 2022; 23:253-260. [PMID: 35035296 DOI: 10.7224/1537-2073.2020-062] [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: 11/18/2022]
Abstract
Background Many individuals with multiple sclerosis (MS) depart the workforce prematurely. In the United States, access to insurance, including health, disability income, long-term care, and life insurance, is largely employment-based or purchased from earnings. Many individuals we see in the clinic experience financial hardship because of a lack of insurance, even if working. We sought to determine the proportion of workers who are financially protected through insurance coverage and the sources of this coverage in a large sample. Methods We developed an online survey and opened it to individuals aged 18 to 65 years registered with the North American Research Committee on Multiple Sclerosis, iConquerMS, or the National Multiple Sclerosis Society Minority Advisory Council. Data collected included demographic and disease characteristics, current information about each insurance type (coverage vs no coverage), and when the current insurance policies were obtained relative to MS diagnosis. Results Of 2507 survey respondents, 82.9% were female, 3.8% Hispanic/Latino, and 91.2% White. The mean ± SD age was 53.5 ± 8.5 years and disease duration was 16.4 ± 8.5 years after diagnosis. The most frequently held insurance types were health (96.3%) and life (58.8%). Only 9.7% of respondents had long-term care insurance. Except for life insurance, most current policies were obtained after MS diagnosis. Conclusions Individuals with MS might not prioritize the possible short- and long-term benefits of these types of insurance. Health care providers can direct patients to nonprofit agencies that educate about of these insurance types and emphasize that others with MS have obtained these insurance types after their diagnosis.
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Affiliation(s)
| | - Stacey S Cofield
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA (SSC)
| | | | - Sarah E Givens
- Francis Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA (SEG, CCM)
| | - Amber Salter
- Division of Biostatistics, School of Medicine, Washington University in St Louis, St Louis, MO, USA (AS [now at UT Southwestern Medical Center])
| | - Hollie K Schmidt
- Accelerated Cure Project for Multiple Sclerosis, Waltham, MA, USA (HKS)
| | - Sabrina Corlette
- Center on Health Insurance Reforms, Georgetown University Health Policy Institute, Washington, DC, USA (SC)
| | - Carol C Musil
- Francis Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA (SEG, CCM)
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22
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Cohan SL, Benedict RHB, Cree BAC, DeLuca J, Hua LH, Chun J. The Two Sides of Siponimod: Evidence for Brain and Immune Mechanisms in Multiple Sclerosis. CNS Drugs 2022; 36:703-719. [PMID: 35725892 PMCID: PMC9259525 DOI: 10.1007/s40263-022-00927-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 12/13/2022]
Abstract
Siponimod is a selective sphingosine 1-phosphate receptor subtype 1 (S1P1) and 5 (S1P5) modulator approved in the United States and the European Union as an oral treatment for adults with relapsing forms of multiple sclerosis (RMS), including active secondary progressive multiple sclerosis (SPMS). Preclinical and clinical studies provide support for a dual mechanism of action of siponimod, targeting peripherally mediated inflammation and exerting direct central effects. As an S1P1 receptor modulator, siponimod reduces lymphocyte egress from lymph nodes, thus inhibiting their migration from the periphery to the central nervous system. As a result of its peripheral immunomodulatory effects, siponimod reduces both magnetic resonance imaging (MRI) lesion (gadolinium-enhancing and new/enlarging T2 hyperintense) and relapse activity compared with placebo. Independent of these effects, siponimod can penetrate the blood-brain barrier and, by binding to S1P1 and S1P5 receptors on a variety of brain cells, including astrocytes, oligodendrocytes, neurons, and microglia, exert effects to modulate neural inflammation and neurodegeneration. Clinical data in patients with SPMS have shown that, compared with placebo, siponimod treatment is associated with reductions in levels of neurofilament light chain (a marker of neuroaxonal damage) and thalamic and cortical gray matter atrophy, with smaller reductions in MRI magnetization transfer ratio and reduced confirmed disability progression. This review examines the preclinical and clinical data supporting the dual mechanism of action of siponimod in RMS.
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Affiliation(s)
- Stanley L Cohan
- Providence Multiple Sclerosis Center, Providence Brain Institute, 9135 SW Barnes Rd Suite 461, Portland, OR, 97225, USA.
| | | | - Bruce A C Cree
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | - Le H Hua
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Jerold Chun
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
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23
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Gheysvandi E, Mohammadi SZ, Amirkiyasar MN, Rad EH, Kouchakinejad-Eramsadati L, Mohtasham-Amiri Z. Measuring Catastrophic Costs in Families Facing Traumatic Brain Injury in Iran. Korean J Neurotrauma 2022; 19:53-62. [PMID: 37051037 PMCID: PMC10083442 DOI: 10.13004/kjnt.2022.18.e46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/04/2022] [Accepted: 08/15/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives Traumatic brain injury (TBI) is preventable and expensive. The medical costs of TBI can be too high for some households and might lead to poverty, malnutrition, and loss of assets, which are called catastrophic expenditures. In this study, we investigated the incidence of catastrophic costs associated with TBI caused by road accidents in a province in northern Iran. Methods This prospective study involved a 1-year follow-up after the accident. Data of 220 patients were collected from the medical records of the Poursina Hospital, Rasht, Iran from March 2018 to February 2020. Direct and indirect costs faced by the households of patients with TBI and catastrophic costs related to TBI were calculated. Regression models were obtained and sensitivity analyses were performed at the end of the study. Results In total, the prevalence of households TBI-related catastrophic costs (TBICC) was 45.5% . Households of female patients (odds ratio [OR]: 0.289, p=0.042), households of retired patients (OR: 0.053, p=0.005), and households falling in the fifth quintile of wealth (OR: 0.370, p=0.050) faced lower TBICC compared to other groups. The Activities of Daily Living scores had a significant negative relationship with TBICC. Conclusions Political interventions such as implementation of insurance schemes, exemptions from payment for certain groups, identification of poor households, and coverage of assistance services can protect households from catastrophic health expenditures.
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Affiliation(s)
- Elham Gheysvandi
- School of Medical Sciences, Khomein University of Medical Sciences, Khomein, Iran
- Molecular and Medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran
| | - Seyedeh Zahra Mohammadi
- Student Research Committee, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Enayatollah Homaie Rad
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Zahra Mohtasham-Amiri
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
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24
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Comparing traditional modeling approaches versus predictive analytics methods for predicting multiple sclerosis relapse. Mult Scler Relat Disord 2022; 57:103330. [PMID: 35158444 DOI: 10.1016/j.msard.2021.103330] [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: 09/02/2021] [Revised: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study compared traditional statistical methods to different predictive analytics methods on the endpoint of multiple sclerosis (MS) relapse. STUDY SETTING This is a secondary data analysis on four different MS Centers based on the third year of data, July 2019-June 2020. STUDY DESIGN The parent study is a two-part, 3-year clinical quality improvement prospective study that started in June 2017 and concluded in June 2020, and utilizes a prospective stepped-wedge randomized design. Binary logistic regression was compared with other machine learning models, specifically ridge, least absolute shrinkage and selection operator (LASSO), and random forest. DATA COLLECTION This study used electronic health record data extracted at the individual level and 'rolled up' to the system and population level. Inclusion criteria included participants aged 18 years or older, with MS presenting to any of the four centers, who entered the study in any quarter. Exclusion criteria included cases with missing or incorrectly input data and those who refused to participate in the study. PRINCIPAL FINDINGS When comparing relapse indices across models, random forest significantly outperformed logistic regression and other machine learning algorithms (ΔperfA =27.1%, ΔperfM =27.5%). However, for ΔperfF, logistic regression and random forest performed relatively the same. Ridge and LASSO outperformed logistic regression (ΔperfM1 =0.9%, ΔperfM2 =9.4%, ΔperfF2=25.8%, respectively). CONCLUSION Multiple sclerosis is a complex and costly chronic ("3C") condition that currently has no cure. In a condition like MS, which has an unpredictable course, the use of predictive analytics could help health systems learn better, faster, and to improve more effectively and predict rather than react to emerging health needs for people with MS. Comparing the predictability of relapse across various models with a predictive analytics framework can potentially change how we manage MS care.
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25
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Tirado-Valencia P, Ayuso S, Fernández-Rodríguez V. Accounting for Emotional Value: A Review in Disability Organizations. Front Psychol 2021; 12:741897. [PMID: 34630255 PMCID: PMC8497962 DOI: 10.3389/fpsyg.2021.741897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022] Open
Abstract
The aim of this paper is to examine how disability organizations account for the emotional value they create for their stakeholders. Based on a review of the literature on emotional value measurement in third sector organizations working in the disability sector, we investigate to what extent emotional value is considered in their social accounting process and what type of value variables, indicators and proxies are used. The results reveal that the analysis of some quality of life domains provides appropriate evidence to represent the emotional value generated by these organizations but that there is a great dispersion in applied instruments and methodologies. The study improves the knowledge and understanding of existing approaches to capture the emotional component of social value creation and contributes to its standardization. Our analysis has implications for the management of disability organizations that can use social accounting to evaluate their performance and improve their effectiveness and efficiency, showing a more complete picture of the social value generated. Likewise, it can be an instrument to make the contribution and social benefits of these organizations visible in all their breadth, improving transparency and legitimacy.
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Affiliation(s)
| | - Silvia Ayuso
- Mango Chair in Corporate Social Responsibility, ESCI-UPF, Pompeu Fabra University, Barcelona, Spain
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26
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Ziaie S, Namazi N, Afzal G, Barati S, Mohebbi R, Mir M, Esmaily H, Mehralian G. Assessing multiple sclerosis-related quality of life among Iranian patients using the MSQOL-54 tool: a cross-sectional study. BMC Neurol 2021; 21:333. [PMID: 34465284 PMCID: PMC8406745 DOI: 10.1186/s12883-021-02357-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 08/16/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic autoimmune disease and is one of the most costly medical conditions that imposed families with catastrophic health expenditures. There is an increasing trend in using alternative medicines including, dietary supplements, herbs, vitamins, and minerals. To date, the association between dietary as well as herbal supplements and QoL in MS patients is under researched; thus, this study aimed to assess the association between the self-reported supplement used and QoL between MS patients. METHODS This cross-sectional study was conducted on patients with MS referring to Shahid Kazemi Pharmacy, based in the city of Tehran, Iran, as a national pharmacy providing specialized pharmaceutical products and pharmaceutical care to patients. The Multiple Sclerosis Quality of Life-54 (MSQoL-54) tools was performed to evaluate MS patients QoL. RESULTS A total number of 382 patients with MS participated in this study. They include 89 (23.3%) men and 293 (76.7%) women, aged 40 ± 10.9 years old. The overall score of the MSQoL-54 questionnaire was 41.58 out of 100. Physical health composite (PHC) and mental health composite (MHC) were 69.60 and 62.99 from 100, respectively. This study revealed that 76.4% of patients used at least one vitamin daily; 92.4% of patients do not receive any herbal product. Vitamin D is the most widely used supplement, followed by calcium, while vitamin C is the least consumed. No correlation was observed regarding supplement use and overall QoL, PHC, or MHC. There were no significant differences between QoL's dimensions score in patients who used supplements. The results showed that increasing the number of supplements used did not relate to overall QoL, PHC, or MHC. In addition, there was not any correlation between the duration used of supplements and QoL's dimensions score in MS patients (p-value> 0.05). CONCLUSIONS The dietary supplement appears to be popular among MS patients. The study results showed that the number of supplementations and their long-term use in patients with MS were not associated with higher QoL. Similarly, the herbal supplements have failed to improve QoL.
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Affiliation(s)
- Shadi Ziaie
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloofar Namazi
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golnaz Afzal
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Saghar Barati
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rezvaneh Mohebbi
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshad Mir
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadi Esmaily
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Gholamhossein Mehralian
- Department of Pharmaco-economics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical sciences, Tehran, Iran.
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27
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Fitzgerald SR, Norman R, Sinha SK, Romanovsky L. Quality improvement outcomes from the introduction of a geriatrician into a rehabilitation setting. J Am Geriatr Soc 2021; 69:2648-2658. [PMID: 34062613 DOI: 10.1111/jgs.17297] [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: 02/18/2021] [Revised: 04/14/2021] [Accepted: 05/01/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Geriatrician impact on patient and system outcomes in formal rehabilitation settings has not been well described to date. We studied the effect of adding a geriatric medicine consultation service to a geriatric focused rehabilitation setting providing care to dialysis and non-dialysis patients. DESIGN/SETTING/PARTICIPANTS A pre- and post-retrospective observational cohort study from January 1, 2009 to June 30, 2019 on all consecutively admitted adults aged 65 and older to general rehabilitation program, and adults aged 60 and older to specialized dialysis rehabilitation program, within a 25 bed general rehabilitation unit in a large urban academic rehabilitation center in Toronto, Ontario. Data were analyzed with quality improvement methodology including Statistical Process Control charts (XmR and U charts). INTERVENTION Addition of a geriatric medicine service providing automatic comprehensive geriatric assessment and co-management consultative services for all admitted patients from admission onwards who met criteria for the intervention. The intervention commenced on August 1, 2013. MEASUREMENTS Outcome measures were length of stay (days), service interruption frequency, and average functional independence measure (FIM) change (discharge FIM minus admission FIM) which uses the validated FIM score, a marker of functional ability. A 22 point change in FIM score is clinically relevant. RESULTS Patient characteristics: general rehabilitation patients (n = 1395, mean age = 79.7, 50.1% female) and dialysis rehabilitation patients (n = 838, mean age = 72.8, 41.8% female). The average FIM change following intervention improved from 20.8 to 29.3 in the general rehabilitation cohort (40.6% improvement, SD = 5.51) and from 22.1 to 30.6 in the dialysis rehabilitation cohort (38.6% improvement, SD = 5.88). Changes in length of stay (24.9%-28.1% reduction) and service interruption frequency (34.3%-49.7% reduction) were also observed. CONCLUSION Introduction of a geriatric medicine service for rehabilitation inpatients was associated with significant FIM score improvements. Our results suggest this intervention contributes to important gains in functional independence in reduced time for older adults receiving inpatient rehabilitative care.
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Affiliation(s)
| | - Richard Norman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Geriatric Medicine and General Internal Medicine, Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
| | - Samir K Sinha
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Geriatric Medicine and General Internal Medicine, Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
| | - Lindy Romanovsky
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Geriatric Medicine and General Internal Medicine, Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
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28
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Roux J, Kingwell E, Zhu F, Tremlett H, Leray E. Care consumption of people with multiple sclerosis: A multichannel sequence analysis in a population-based setting in British Columbia, Canada. Mult Scler 2021; 28:309-322. [PMID: 34048293 DOI: 10.1177/13524585211016726] [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: 11/16/2022]
Abstract
BACKGROUND Persons with multiple sclerosis (PwMS) typically require complex multidisciplinary care, which is rarely formally assessed. OBJECTIVES We applied multichannel sequence analysis (MCSA) to identify care consumption patterns by PwMS in British Columbia, Canada. METHODS We created two cohorts, comprising incident and prevalent MS cases, using linked clinical and administrative data. We applied MCSA to quantify and compare the care pathways of PwMS, based on all-cause hospitalizations and physician visits (divided into five specialities). Care consumption clusters were characterized using demographic and clinical features. RESULTS From 1048 incident and 3180 prevalent PwMS, the MCSA identified 12 and 6 distinct care consumption clusters over a median follow-up of 9.6 and 13.0 years, respectively. Large disparities between clusters were observed; the median number of annual consultations ranged from 5.6 to 21.3 for general practitioners, 1.2 to 4.6 for neurologists and 0 to 5.3 for psychiatrists in the incident cohort. Characteristics at MS symptom onset associated with the highest care consumption included high comorbidity burden and older age. There were similar disparities and associations for prevalent PwMS. CONCLUSION The distinct patterns of care consumption, which were reminiscent of the heterogeneity of MS itself, may facilitate health service planning and evaluation, and provide a novel outcome measure in health research.
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Affiliation(s)
- Jonathan Roux
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and Health Services Research), Rennes, France/Inserm CIC-P 1414, CHU of Rennes, Rennes, France
| | - Elaine Kingwell
- Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada/Research Department of Primary Care & Population Health, University College London, London, UK
| | - Feng Zhu
- Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - Helen Tremlett
- Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - Emmanuelle Leray
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and Health Services Research), Rennes, France/Inserm CIC-P 1414, CHU of Rennes, Rennes, France
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29
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Giovannoni G, Kappos L, de Seze J, Hauser SL, Overell J, Koendgen H, Manfrini M, Wang Q, Wolinsky JS. Risk of requiring a walking aid after 6.5 years of ocrelizumab treatment in patients with relapsing multiple sclerosis: Data from the OPERA I and OPERA II trials. Eur J Neurol 2021; 29:1238-1242. [PMID: 33724637 PMCID: PMC9290576 DOI: 10.1111/ene.14823] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/05/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022]
Abstract
Background and purpose Requiring a walking aid is a fundamental milestone in multiple sclerosis (MS), represented by an Expanded Disability Status Scale (EDSS) score ≥6.0. In the present study, we assess the effect of ocrelizumab (OCR) on time to EDSS score ≥6.0 in relapsing MS. Methods Time to EDSS score ≥6.0 confirmed for ≥24 and ≥48 weeks was assessed over the course of 6.5 years (336 weeks) in the double‐blind period (DBP) and open‐label extension (OLE) period of the OPERA I (NCT01247324) and OPERA II (NCT01412333) studies. Results Time to reach EDSS score ≥6.0 was significantly delayed in those initially randomized to OCR versus interferon. Over 6.5 years, the risk of requiring a walking aid confirmed for ≥24 weeks was 34% lower among those who initiated OCR earlier versus delayed treatment (average hazard ratio [HR] DBP + OLE 0.66, 95% confidence interval [CI] 0.45–0.95; p = 0.024); the risk of requiring a walking aid confirmed for ≥48 weeks was 46% lower (average HR DBP+OLE 0.54, 95% CI 0.35–0.83; p = 0.004). Conclusion The reduced risk of requiring a walking aid in earlier initiators of OCR demonstrates the long‐term implications of earlier highly effective treatment.
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Affiliation(s)
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience and MS Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | | | | | | | | | | | - Qing Wang
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Jerry S Wolinsky
- McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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30
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Bonafede M, Mehta R, Kim G, Sruti I, Tian M, Pelletier C, Goldfarb N. Productivity Loss and Associated Costs Among Employed Patients Receiving Disease-Modifying Treatment for Multiple Sclerosis. PHARMACOECONOMICS - OPEN 2021; 5:23-34. [PMID: 33051856 PMCID: PMC7895882 DOI: 10.1007/s41669-020-00233-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The aim of this study was to examine the indirect burden of employed multiple sclerosis (MS) patients initiating disease-modifying therapies (DMTs) in the US. METHODS DMT-treated MS patients (DMT users) and direct-matched controls without MS (1:3) were captured using the IBM MarketScan Commercial Claims and Encounters Database and the Health and Productivity Management Database between 1 January 2009 and 1 January 2017. DMT users were also stratified by route of administration. Time loss and costs from absenteeism, short-term disability, and long-term disability were assessed for DMT users and matched controls. RESULTS A total of 3022 DMT users were matched to 9066 controls. Compared with injectable DMT users, oral DMT users took twice as long to initiate therapy but had numerically lower absenteeism costs and significantly lower long-term disability costs in the first year after DMT initiation. The mean (standard deviation) indirect costs of absenteeism, short-term disability, and long-term disability were US$6474 (US$6779), US$2368 (US$5777), and US$280 (US$2578), respectively, for DMT users and US$4468 (US$3814), US$328 (US$1950), and US$36 (US$938), respectively, for controls in the first year (all p < 0.001). CONCLUSIONS Employed DMT users in the US incurred incremental increased indirect burden ($2007 in absenteeism, $2040 in short-term disability, and $244 in long-term disability) compared with matched controls. Despite evidence of delays in treatment initiation, oral DMT users had evidence of reduced work loss compared with injectable users, suggesting that open access to all treatment options may reduce the indirect burden of MS. Additional research into the impact of route of administration on the burden of long-term disability among MS patients is needed.
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Affiliation(s)
| | - Rina Mehta
- Bristol-Myers Squibb Company, Princeton, NJ, USA
| | - Gilwan Kim
- IBM Watson Health, 75 Binney St, Cambridge, MA, 02142, USA.
| | - Ila Sruti
- IBM Watson Health, 75 Binney St, Cambridge, MA, 02142, USA
| | - Marc Tian
- Bristol-Myers Squibb Company, Princeton, NJ, USA
| | | | - Neil Goldfarb
- Greater Philadelphia Business Coalition on Health, Philadelphia, PA, USA
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31
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Lo J, Chan L, Flynn S. A Systematic Review of the Incidence, Prevalence, Costs, and Activity and Work Limitations of Amputation, Osteoarthritis, Rheumatoid Arthritis, Back Pain, Multiple Sclerosis, Spinal Cord Injury, Stroke, and Traumatic Brain Injury in the United States: A 2019 Update. Arch Phys Med Rehabil 2021; 102:115-131. [PMID: 32339483 PMCID: PMC8529643 DOI: 10.1016/j.apmr.2020.04.001] [Citation(s) in RCA: 170] [Impact Index Per Article: 56.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/03/2020] [Accepted: 04/05/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To present recent evidence on the prevalence, incidence, costs, activity limitations, and work limitations of common conditions requiring rehabilitation. DATA SOURCES Medline (PubMed), SCOPUS, Web of Science, and the gray literature were searched for relevant articles about amputation, osteoarthritis, rheumatoid arthritis, back pain, multiple sclerosis, spinal cord injury, stroke, and traumatic brain injury. STUDY SELECTION Relevant articles (N=106) were included. DATA EXTRACTION Two investigators independently reviewed articles and selected relevant articles for inclusion. Quality grading was performed using the Methodological Evaluation of Observational Research Checklist and Newcastle-Ottawa Quality Assessment Form. DATA SYNTHESIS The prevalence of back pain in the past 3 months was 33.9% among community-dwelling adults, and patients with back pain contribute $365 billion in all-cause medical costs. Osteoarthritis is the next most prevalent condition (approximately 10.4%), and patients with this condition contribute $460 billion in all-cause medical costs. These 2 conditions are the most prevalent and costly (medically) of the illnesses explored in this study. Stroke follows these conditions in both prevalence (2.5%-3.7%) and medical costs ($28 billion). Other conditions may have a lower prevalence but are associated with relatively higher per capita effects. CONCLUSIONS Consistent with previous findings, back pain and osteoarthritis are the most prevalent conditions with high aggregate medical costs. By contrast, other conditions have a lower prevalence or cost but relatively higher per capita costs and effects on activity and work. The data are extremely heterogeneous, which makes anything beyond broad comparisons challenging. Additional information is needed to determine the relative impact of each condition.
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Affiliation(s)
- Jessica Lo
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
| | - Leighton Chan
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD.
| | - Spencer Flynn
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
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Berkovich R, Fox E, Okai A, Ding Y, Gorritz M, Bartolome L, Wade RL, Su W, Johnson KM, Russo P. Identifying disability level in multiple sclerosis patients in a U.S.-based health plan claims database. J Med Econ 2021; 24:46-53. [PMID: 33297816 DOI: 10.1080/13696998.2020.1857257] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS In clinical trials, disability progression in multiple sclerosis (MS) is measured by the Kurtzke expanded disability status scale (EDSS), which is not captured in routine clinical care in the U.S. This study developed a claims-based disability score (CDS) based on the EDSS for assigning MS disability level in a U.S. claims database. METHODS This retrospective cohort study of patients with MS in the U.S., utilized adjudicated health plan claims data linked to electronic medical records (EMRs) data. Patients were identified between 1 January 2012 and 31 December 2016 and indexed on the first date of MS diagnosis. The CDS was developed to assign disability level at baseline using claims and ambulatory EMR records observed over the 1-year baseline period. All-cause healthcare costs were assessed by baseline disability level to validate the CDS. RESULTS In total, 45,687 patients were identified in claims (full sample) and 1,599 linked to EMR (core sample). Over half of patients in both samples were classified with mild disability at baseline. Adjusted healthcare costs in patients with moderate and severe disability were 15% (p<.0001) and 20% higher, respectively, than in patients with mild disability at baseline in the full sample. Disease-modifying therapy (DMT) costs accounted for 89%, 82%, and 78% of outpatient pharmacy costs in patients with mild, moderate, and severe disability, respectively. CONCLUSIONS The CDS is the first claims-based measure of MS disability utilizing data from EMR. This novel measure advances the opportunity to examine outcomes by disability accumulation in the absence of standard markers of disease progression. Although formal validation of the CDS was not possible due to lack of available EDSS in the EMR, the economic burden results align with prior publications and show that healthcare costs increase with increasing disability. Future validation studies of the CDS are warranted.
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Affiliation(s)
- Regina Berkovich
- Los Angeles USC General Hospital and Clinic, Los Angeles, CA, USA
| | - Edward Fox
- Central Texas Neurology Consultants, Round Rock, TX, USA
| | - Annette Okai
- Multiple Sclerosis Treatment Center of Dallas, Dallas, TX, USA
| | - Yao Ding
- IQVIA, Inc., Collegeville, PA, USA
| | | | - Lauren Bartolome
- Jefferson College of Population Health, Philadelphia, PA, USA
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Wendy Su
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Patricia Russo
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Annual Cost Burden by Level of Relapse Severity in Patients with Multiple Sclerosis. Adv Ther 2021; 38:758-771. [PMID: 33245532 PMCID: PMC7854428 DOI: 10.1007/s12325-020-01570-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/11/2020] [Indexed: 12/19/2022]
Abstract
Introduction The severity of relapses varies in multiple sclerosis (MS) and may lead to a differential cost burden. This study aimed to characterize the direct healthcare costs associated with relapses in patients with MS by the level of relapse severity. Methods This retrospective analysis used claims data extracted from the MarketScan® Databases from January 1, 2013 to March 31, 2017 (study period January 1, 2012 to March 31, 2018). Adult patients with at least one diagnosis of MS and 12 months of continuous enrollment prior to the first MS diagnosis to 12 months after the index date were included. On the basis of the severity of the relapse, patients were stratified into three cohorts: severe relapse (SR), mild/moderate relapse (MMR), and no relapse (NR). All-cause and MS-related costs were analyzed during the 12-month follow-up period. Group differences were assessed using descriptive and multivariate statistical analyses. Results In total, 8775 patients with MS were analyzed: 6341 (72%) in the NR cohort, 1929 (22%) in the MMR cohort, and 505 (6%) in the SR cohort. Overall, patients were mostly female (76%), mean age was 50 years, and 25% were on a disease-modifying therapy. Mean (standard deviation [SD]) all-cause and MS-related costs among patients with a relapse were higher vs patients without a relapse (all-cause $66,489 [$56,264] vs $41,494 [$48,417]; MS-related $48,700 [$43,364] vs $24,730 [$33,821]). Among patients with a relapse, the mean (SD) all-cause costs were $87,979 [$65,991] vs $60,863 [$51,998] and MS-related costs were $69,586 ($51,187) vs $43,233 [$39,292] for patients in the SR vs MMR cohorts, respectively. A similar trend for increase in cost by relapse severity was observed in the adjusted analysis. Conclusion Total annual all-cause and MS-related costs increased with severity of the relapses. High-efficacy treatments might reduce the severity of the relapses, thereby reducing the cost of care in patients with MS.
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Kantor D, Mehta R, Pelletier C, Tian M, Noxon V, Johnson BH, Bonafede M. Treatment Patterns and Relapses Among Newly Treated Multiple Sclerosis Patients From a Retrospective Claims Analysis. Clin Ther 2020; 42:2136-2147.e3. [PMID: 33160682 DOI: 10.1016/j.clinthera.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Although all disease-modifying therapies (DMTs) reduce risk of relapse in multiple sclerosis (MS), many factors, including route of administration, influence selection of first-line DMT. Knowledge of real-world treatment patterns and effectiveness in reducing relapses across DMTs is important to understanding factors influencing this choice. This study sought to describe treatment patterns and relapses among newly treated adults with MS and by DMT route of administration (oral, injectable, and infusion). METHODS IBM MarketScan research databases were used to identify MS adults newly initiating DMTs (index event) from January 1, 2011-April 1, 2016, who had 12 months of continuous preindex and postindex medical and pharmacy benefits. Newly treated patients were those with ≥2 nondiagnostic claims with an International Classification of Diseases, Ninth Revision, Clinical Modification (340) or Tenth Revision, Clinical Modification (G35) code and no DMT prescription claims in the 12 months' preindex. Persistence and adherence were measured from index until the earliest of ≥60 days without DMT, switching DMTs, or end of follow-up. Relapses were defined using a validated claims-based algorithm and measured in the 12-month preindex and postindex periods. Regression analysis adjusting for patient characteristics and prior relapses was used to determine the association between DMT route of administration and odds of 12-month persistence, odds of postindex relapse, and number of postindex relapses. FINDINGS Of 9378 newly treated MS patients meeting inclusion criteria; average age was 46.7 years, and 73.3% were female. Most patients initiated an injectable (65.5%) or oral (26.1%) DMT. Relapses decreased markedly from preindex to postindex (32.9%-24.0%), which was highest among oral users (35.8%-21.6%). Patients with no (vs ≥3) relapses preindex were more likely to be relapse free postindex (81.6% vs 31.4%). Nonpersistence (39.1% overall) was lowest among oral users (33.4%) and higher among those with versus without a postindex relapse (50.6% vs 35.5%). Patients initiating oral versus injectable agents were more likely to be persistent at 12 months (odds ratio [OR], 1.45; p < 0.0001) and less likely to relapse (OR, 0.75; p < 0.0001) postindex. Switches were uncommon (~10%) across cohorts. Preindex relapses were associated with increased odds of postindex relapses (OR, 1.73; p < 0.0001) but not with odds of persistence at 12 months. IMPLICATIONS The 12-month nonpersistence rate was high among all MS patients but lower among oral users. Oral users were also less likely to relapse postindex. Despite the effectiveness of DMTs in reducing relapses, the low persistence, lack of switching to a new DMT, and continued relapses highlight an unmet need in the MS treatment landscape.
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Affiliation(s)
- Daniel Kantor
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Rina Mehta
- Bristol-Myers Squibb Company, Princeton, NJ, USA
| | | | - Marc Tian
- Bristol-Myers Squibb Company, Princeton, NJ, USA
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Hassett L, Tiedemann A, Hinman RS, Crotty M, Hoffmann T, Harvey L, Taylor NF, Greaves C, Treacy D, Jennings M, Milat A, Bennell KL, Howard K, van den Berg M, Pinheiro M, Wong S, Kirkham C, Ramsay E, O'Rourke S, Sherrington C. Physical activity coaching for adults with mobility limitations: protocol for the ComeBACK pragmatic hybrid effectiveness-implementation type 1 randomised controlled trial. BMJ Open 2020; 10:e034696. [PMID: 33148720 PMCID: PMC7640503 DOI: 10.1136/bmjopen-2019-034696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Mobility limitation is common and often results from neurological and musculoskeletal health conditions, ageing and/or physical inactivity. In consultation with consumers, clinicians and policymakers, we have developed two affordable and scalable intervention packages designed to enhance physical activity for adults with self-reported mobility limitations. Both are based on behaviour change theories and involve tailored advice from physiotherapists. METHODS AND ANALYSIS This pragmatic hybrid effectiveness-implementation type 1 randomised control trial (n=600) will be undertaken among adults with self-reported mobility limitations. It aims to estimate the effects on physical activity of: (1) an enhanced 6-month intervention package (one face-to-face physiotherapy assessment, tailored physical activity plan, physical activity phone coaching from a physiotherapist, informational/motivational resources and activity monitors) compared with a less intensive 6-month intervention package (single session of tailored phone advice from a physiotherapist, tailored physical activity plan, unidirectional text messages, informational/motivational resources); (2) the enhanced intervention package compared with no intervention (6-month waiting list control group); and (3) the less intensive intervention package compared with no intervention (waiting list control group). The primary outcome will be average steps per day, measured with the StepWatch Activity Monitor over a 1-week period, 6 months after randomisation. Secondary outcomes include other physical activity measures, measures of health and functioning, individualised mobility goal attainment, mental well-being, quality of life, rate of falls, health utilisation and intervention evaluation. The hybrid effectiveness-implementation design (type 1) will be used to enable the collection of secondary implementation outcomes at the same time as the primary effectiveness outcome. An economic analysis will estimate the cost-effectiveness and cost-utility of the interventions compared with no intervention and to each other. ETHICS AND DISSEMINATION Ethical approval has been obtained by Sydney Local Health District, Royal Prince Alfred Zone. Dissemination will be via publications, conferences, newsletters, talks and meetings with health managers. TRIAL REGISTRATION NUMBER ACTRN12618001983291.
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Affiliation(s)
- Leanne Hassett
- Institute for Musculoskeletal Health, University of Sydney/ Sydney Local Health District, Sydney, New South Wales, Australia
- Discipline of Physiotherapy, Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, University of Sydney/ Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tammy Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Lisa Harvey
- John Walsh Centre for Rehabilitation Research, Northern Clinical School, The University of Sydney, St Leonards, New South Wales, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, New South Wales, Australia
| | - Colin Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Daniel Treacy
- Institute for Musculoskeletal Health, University of Sydney/ Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
- Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Matthew Jennings
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Andrew Milat
- School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
- NSW Ministry of Health, Liverpool, New South Wales, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kirsten Howard
- School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Maayken van den Berg
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Marina Pinheiro
- Institute for Musculoskeletal Health, University of Sydney/ Sydney Local Health District, Sydney, New South Wales, Australia
- Discipline of Physiotherapy, Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Siobhan Wong
- Institute for Musculoskeletal Health, University of Sydney/ Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Catherine Kirkham
- Institute for Musculoskeletal Health, University of Sydney/ Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Elizabeth Ramsay
- Institute for Musculoskeletal Health, University of Sydney/ Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Sandra O'Rourke
- Institute for Musculoskeletal Health, University of Sydney/ Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, University of Sydney/ Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
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Toliver J, Barner JC, Lawson K, Sonawane K, Rascati K. Replication of a Claims-based Algorithm to Estimate Multiple Sclerosis Disease Severity in a Commercially Insured Population. Mult Scler Relat Disord 2020; 46:102539. [DOI: 10.1016/j.msard.2020.102539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/26/2020] [Accepted: 09/25/2020] [Indexed: 01/23/2023]
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Miller TA, Paul R, Forthofer M, Wurdeman SR. Impact of Time to Receipt of Prosthesis on Total Healthcare Costs 12 Months Postamputation. Am J Phys Med Rehabil 2020; 99:1026-1031. [PMID: 33060371 PMCID: PMC7547875 DOI: 10.1097/phm.0000000000001473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The objective was to assess the impact of a prosthesis and the timing of prosthesis receipt on total direct healthcare costs in the 12-mo postamputation period. DESIGN Data on patients with lower limb amputation (n = 510) were obtained from a commercial claims database for retrospective cohort analysis. Generalized linear multivariate modeling was used to determine differences in cost between groups according to timing of prosthesis receipt compared with a control group with no prosthesis. RESULTS Receipt of a prosthesis between 0 and 3 mos post lower limb amputation yielded a reduced total cost by approximately 0.23 in log scale within 12 mos after amputation when compared with the no-prosthesis group. Despite the included costs of a prosthesis, individuals who received a prosthesis either at 4-6 mos postamputation or 7-9 mos postamputation incurred costs similar to the no-prosthesis group. CONCLUSION Earlier receipt of a prosthesis is associated with reduced spending in the 12 mos postamputation of approximately $25,000 compared with not receiving a prosthesis. The results of this study suggest that not providing or delaying the provision of a prosthesis increases costs by about 25%.
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Affiliation(s)
- Taavy A Miller
- From the Department of Public Health, University of North Carolina at Charlotte, Charlotte, North Carolina (TAM, RP, MF); Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, Texas (TAM, SRW); and Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska (SRW)
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Okoye EC, Onwuakagba IU, Ani KU, Babatunde JK, Akosile CO, Okeke MC, Aronu AE. Body image, physical activity, quality of life, and community reintegration of individuals with acquired mobility disability in a Nigerian population. Disabil Rehabil 2020; 44:2002-2010. [PMID: 32924653 DOI: 10.1080/09638288.2020.1817159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the quality of life (QOL), physical activity (PA), community reintegration (CR), and body image (BI) among adults with acquired mobility disabilities. Relationships between the constructs were also assessed in order to ascertain how a change in one construct could influence the other. MATERIALS AND METHODS This cross-sectional survey involved 157 adults (mean age = 47.51 ± 21.08 years) consecutively recruited from conveniently selected centers in South-east Nigeria. The Short-Form 36-Item Health Survey, the Multidimensional Body Self Relations, the Reintegration to Normal Living Index, and the Short-Form 7-Day International Physical Activity questionnaires were used to assess participants' QOL, BI, CR, and PA respectively. Participants' scores and socio-demographic information were summarised using descriptive statistics while the Spearman test analysed the relationships between constructs. RESULTS Participants' mean QOL (43.23 ± 13.07), CR (48.09 ± 22.84), and BI (2.91 ± 0.51) scores were poor while their mean PA score (4.39 ± 4.56 × 103 MET-min/week) was high. PA had significant positive relationships with CR (rho = 0.25; p < 0.01) and QOL (rho = 0.33; p < 0.01). BI had a significant positive relationship with CR (rho = 0.28; p = 0.01). CONCLUSIONS PA was high for this sample of individuals with mobility disability receiving physiotherapy but QOL, CR, and BI were poor. Based on observed correlations, rehabilitation interventions for enhancing PA may help improve QOL and CR.IMPLICATIONS FOR REHABILITATIONMobility disabilities are very common and burdensome in Nigeria and other African countries.Quality of life, physical activity, community reintegration, and body image can be adversely affected among individuals with mobility disabilities.Understanding relationships between these constructs among individuals with mobility disabilities could help in enhancing rehabilitation planning and outcomes.Physical activity relates to both community reintegration and life quality, whereas body image relates to community integration.
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Affiliation(s)
- Emmanuel Chiebuka Okoye
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - Ifeoma Uchenna Onwuakagba
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - Kenneth Umezulike Ani
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - Jacob Kolawole Babatunde
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Nigeria
| | | | - Monique Chinyere Okeke
- Department of Environmental Health Sciences, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - Ann Ebele Aronu
- Department of Paediatrics, College of Medicine, University of Nigeria, Enugu, Nigeria
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Plow M, Packer T, Mathiowetz VG, Preissner K, Ghahari S, Sattar A, Bethoux F, Finlayson M. REFRESH protocol: a non-inferiority randomised clinical trial comparing internet and teleconference to in-person 'Managing Fatigue' interventions on the impact of fatigue among persons with multiple sclerosis. BMJ Open 2020; 10:e035470. [PMID: 32801193 PMCID: PMC7430436 DOI: 10.1136/bmjopen-2019-035470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system. It is considered a major cause of non-traumatic disability in young adults. One of the most common and disabling symptoms of MS is fatigue. MS fatigue can impact all aspects of quality of life, including physical, mental and social function. Fortunately, fatigue self-management interventions, such as 'Managing Fatigue: A 6 week energy conservation course', can decrease the impact of fatigue and improve health-related quality of life. The purpose of this study is to compare three modes of delivering the Managing Fatigue intervention-two remote delivery formats (teleconference and internet) and one in-person format-on perceptions of fatigue and its impact on physical, mental and social function. METHODS AND ANALYSIS A non-inferiority randomised clinical trial is being conducted to compare the three delivery formats (1:1:1 allocation ratio) among 582 participants with MS living in the Midwestern and Northeastern United States. The hypothesis is that teleconference and internet versions of the intervention are non-inferior to the traditional mode of clinical service delivery (ie, one to one, in person) in terms of the primary outcome of self-reported fatigue impact (ie, Fatigue Impact Scale) and the secondary outcome of health-related quality of life (ie, Multiple Sclerosis Impact Scale). Outcomes are being measured at baseline, 2 months, 3 months and 6 months. The primary analysis tool will be linear mixed effects model. The prespecified inferiority margin for the primary outcome is 10 points. We will also examine whether baseline characteristics (eg, sociodemographic) moderate outcomes of the Managing Fatigue intervention and whether changes in self-efficacy and fatigue self-management behaviours mediate changes in outcomes. ETHICS AND DISSEMINATION The protocol is approved centrally by the institutional review board at Case Western Reserve University. Eligible participants give consent before being enrolled and randomised into the study. The study results will be disseminated through relevant advocacy organisations, newsletters to participants, publication in peer-reviewed journals and presentations at scientific conferences. TRIAL REGISTRATION NUMBER NCT03550170; Pre-results.
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Affiliation(s)
- Matthew Plow
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Tanya Packer
- School of Occupational Therapy and School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Virgil G Mathiowetz
- Program in Occupational Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kathy Preissner
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Abdus Sattar
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Francois Bethoux
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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Al-Sakran L, Marrie RA, Blackburn D, Knox K, Evans C. Impact of comorbidity on hospitalizations in individuals newly diagnosed with multiple sclerosis: A longitudinal population-based study. Mult Scler Relat Disord 2020; 40:101955. [DOI: 10.1016/j.msard.2020.101955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 01/29/2023]
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Wolinsky JS, Engmann NJ, Pei J, Pradhan A, Markowitz C, Fox EJ. An exploratory analysis of the efficacy of ocrelizumab in patients with multiple sclerosis with increased disability. Mult Scler J Exp Transl Clin 2020; 6:2055217320911939. [PMID: 32206332 PMCID: PMC7079307 DOI: 10.1177/2055217320911939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/06/2020] [Accepted: 02/16/2020] [Indexed: 11/16/2022] Open
Abstract
Background Ocrelizumab, an anti-CD20 humanized monoclonal antibody, reduced disease progression in pivotal trials of patients with relapsing (OPERA I, OPERA II) and primary progressive (ORATORIO) multiple sclerosis (MS). These effects may be particularly important among patients with increased disability. Objective In this post hoc exploratory analysis, we evaluated the efficacy of ocrelizumab on disability progression among a subgroup of patients with MS who had increased baseline disability levels (Expanded Disability Status Scale scores ≥4.0) in the pivotal trials. Methods During the double-blind period, patients received ocrelizumab 600 mg intravenously every 24 weeks for 96 weeks in the OPERA trials (versus interferon β-1a 44 μg subcutaneously three times per week) and for 120 weeks in ORATORIO (versus placebo). Kaplan–Meier and Cox survival analyses were used to assess disability outcome measures. Results Baseline demographic, disease, and treatment characteristics were generally comparable across treatment groups in patients with increased disability from the OPERA and ORATORIO trials. Ocrelizumab treatment numerically, and in some instances significantly, reduced confirmed disability progression versus the comparator in these patients. Conclusions In patients with increased baseline disability, ocrelizumab reduced the risk of confirmed disability progression versus interferon β-1a in patients with relapsing-onset MS and versus placebo in patients with progression-onset MS.
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Affiliation(s)
- Jerry S Wolinsky
- McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | | | | | | | - Clyde Markowitz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward J Fox
- Central Texas Neurology Consultants, Round Rock, TX, USA
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Moral Torres E, Fernández Fernández Ó, Carrascal Rueda P, Ruiz-Beato E, Estella Pérez E, Manzanares Estrada R, Gómez-García T, Jiménez M, Hidalgo-Vega Á, Merino M. Social value of a set of proposals for the ideal approach of multiple sclerosis within the Spanish National Health System: a social return on investment study. BMC Health Serv Res 2020; 20:84. [PMID: 32019531 PMCID: PMC7001370 DOI: 10.1186/s12913-020-4946-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease that in many cases produces disability, having a high impact in patients' lives, reducing significantly their quality of life. The aim of this study was to agree on a set of proposals to improve the current management of MS within the Spanish National Health System (SNHS) and apply the Social Return on Investment (SROI) method to measure the potential social impact these proposals would create. METHODS A Multidisciplinary Working Team of nine experts, with representation from the main stakeholders regarding MS, was set up to agree on a set of proposals to improve the management of MS. A forecast SROI analysis was carried out, with a one-year timeframe. Data sources included an expert consultation, a narrative literature review and a survey to 532 MS patients. We estimated the required investment of a hypothetical implementation, as well as the potential social value that it could create. We calculated outcomes in monetary units and we measured intangible outcomes through financial proxies. RESULTS The proposed ideal approach revealed that there are still unmet needs related to MS that can be addressed within the SNHS. Investment would amount to 148 million € and social return to 272 million €, so each euro invested could yield almost €2 of social return. CONCLUSIONS This study could guide health interventions, resulting in money savings for the SNHS and increases in patients' quality of life.
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Affiliation(s)
- Ester Moral Torres
- Neurology Service, Moisès Broggi Hospital - General Hospital of l'Hospitalet, Barcelona, Spain
| | | | | | | | | | | | | | - Margarita Jiménez
- Pharmacoeconomics and Market Access Department, Weber, Madrid, Spain
| | - Álvaro Hidalgo-Vega
- Economy and Health Research Seminar, Universidad de Castilla-La Mancha, Toledo, Spain
| | - María Merino
- Health Outcomes Research Department, Weber, Calle Moreto, 17, 5 Dcha, 28014, Madrid, Madrid, Spain.
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Commercial ICT Smart Solutions for the Elderly: State of the Art and Future Challenges in the Smart Furniture Sector. ELECTRONICS 2020. [DOI: 10.3390/electronics9010149] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Within a ubiquitous environment, home and office furniture can be maximally utilized to provide ease, especially if the items are designed based on smart technology. For this reason, the acceptance of smart furniture has soared over the years. Given the vast influence of the Internet of Things (IoT) and Industry 4.0 on technological advancement in furniture design, it is imperative to examine information and communication technology (ICT) solutions for the elderly in the context of smart furniture design and implementation. This article presents a review of the state-of-the-art literature in smart solutions for the elderly based on publications under ICT smart solutions for these elderly, along with smart furniture options and manufacturer activities in terms of fixing market prices for these furniture materials. Furthermore, patenting rights on some existing smart furniture designs for the elderly, given the current trends in worldwide acceptance, are examined. Moreover, this article also highlights opportunities introduced by IoT-based solutions for the elderly as current trends in research and their effects on human life. Some smart product examples from different enterprises are also presented. New, innovative and active designs must be developed, focusing upon human healthcare, and in turn providing greater comfort and convenience for elderly people. To fulfil these requirements, the also selected technical aspects of new Smart Furniture solutions in connection to the cost of these solutions are discussed. Simultaneously, Smart Furniture solutions need to be flexible, low-cost, easy to buy and install without expert knowledge, and widely available on the market.
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Al-Sakran L, Marrie RA, Blackburn D, Knox K, Evans C. Association between disease-modifying therapies for multiple sclerosis and healthcare utilisation on a population level: a retrospective cohort study. BMJ Open 2019; 9:e033599. [PMID: 31772108 PMCID: PMC6887031 DOI: 10.1136/bmjopen-2019-033599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Disease-modifying therapy (DMT) use in multiple sclerosis (MS) has increased significantly. However, the impact of DMTs on healthcare use is limited and conflicting, and rarely examined at a population level. This study examined the association between DMTs and healthcare utilisation at the population level. DESIGN Retrospective cohort. SETTING Health administrative data from Saskatchewan, Canada (1997-2016). PARTICIPANTS To test for associations at the population level, we identified two cohorts. The general population cohort included all Saskatchewan residents ≥18 years who were drug plan beneficiaries. The MS cohort included individuals ≥18 years, identified using a validated definition (≥3 hospital, physician or drug claims for MS). MAIN OUTCOME MEASURES AND METHODS To test for an association between the total number of DMT dispensations per year and the total number of hospitalisations we used negative binomial regression fitted with generalised estimating equations (GEE); only hospitalisations that occurred after the date of MS diagnosis (date of first claim for MS or demyelinating disease) were extracted. To test for an association between the number of DMT dispensations and physician claims, negative binomial distributions with GEE were fit as above. Results were reported as rate ratios (RR), with 95% CIs, and calculated for every 1000 DMT dispensations. RESULTS The number of DMT dispensations was associated with a decreased risk for all-cause (RR=0.994; 95% CI 0.992 to 0.996) and MS-specific (RR=0.909; 95% CI 0.880 to 0.938) hospitalisations. The number of DMT dispensations was not associated with the number of all-cause (RR=1.006; 95% CI 0.990 to 1.022) or MS-specific (RR=0.962; 95% CI 0.910 to 1.016) physician claims. CONCLUSION Increased DMT use in Saskatchewan was associated with a reduction in hospitalisations, but did not impact the number of physician services used. Additional research on cost-benefit and differing treatment strategies would provide further insight into the true impact of DMTs on healthcare utilisation at a population level.
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Affiliation(s)
- Lina Al-Sakran
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ruth Ann Marrie
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Blackburn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Katherine Knox
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Nicholas JA, Electricwala B, Lee LK, Johnson KM. Burden of relapsing-remitting multiple sclerosis on workers in the US: a cross-sectional analysis of survey data. BMC Neurol 2019; 19:258. [PMID: 31660897 PMCID: PMC6816180 DOI: 10.1186/s12883-019-1495-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/13/2019] [Indexed: 12/31/2022] Open
Abstract
Background Multiple sclerosis (MS) is prevalent among working age individuals (20–60 years), leading to high burden on work productivity. Few data are available about the absenteeism and presenteeism in employed individuals with MS in comparison to non-MS personnel. This study aimed to quantify the burden of illness of employed US adults with relapsing-remitting multiple sclerosis (RRMS) and examine burden by levels of work impairment. Methods A retrospective cross-sectional analysis was conducted using patient-reported responses from the US National Health and Wellness Survey (NHWS). Data from NHWS 2015–2016 were analyzed from 196 employed RRMS respondents who were matched 1:4 to employed respondents without MS based on demographic and general health characteristics. Demographic and general health characteristics for employed RRMS individuals were analyzed by levels of work impairment (none, 1–30%; 31–68%; 69–100%). Work productivity (absenteeism, presenteeism, and work impairment), decrements in health-related quality of life (HRQoL) (short form-36, EQ-5D), and healthcare resource utilization (HCRU) were compared to determine the burden of RRMS. Results After propensity score matching, the levels of absenteeism and presenteeism were 2 and 1.8 times higher in the employed RRMS population than the employed non-MS population, respectively (P < 0.001 for both). HRQoL was significantly lower in employed respondents with RRMS than those without MS (P < 0.001 for all). Employed respondents with RRMS had significantly more HCRU over 6 months compared to those without MS (P < 0.001). Furthermore, among employed RRMS respondents, greater levels of impairment were associated with increasing disease severity, greater healthcare resource use, fatigue, and cognitive impairment and inversely associated with mental and physical HRQoL (P < 0.0001 for all). Conclusions Among employed individuals, respondents with RRMS had lower, work productivity, HRQoL, and higher HCRU as compared with those without MS. Given the large impact RRMS has on work impairment, a need exists to manage individuals on therapies that improve HRQoL, reduce symptoms, and improve their ability to perform in the workforce.
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Affiliation(s)
- Jacqueline A Nicholas
- OhioHealth Multiple Sclerosis Clinic, Riverside Methodist Hospital, Columbus, OH, USA
| | - Batul Electricwala
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936, USA
| | | | - Kristen M Johnson
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936, USA.
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Dunn-Pirio AM, Heyman BM, Kaufman DS, Kinkel RP. Outcomes and Cost-Effectiveness of Autologous Hematopoietic Cell Transplant for Multiple Sclerosis. Curr Treat Options Neurol 2019; 21:53. [PMID: 31624926 DOI: 10.1007/s11940-019-0588-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW This review presents a critical appraisal of the use of autologous hematopoietic cell transplant (AHCT) for the treatment of multiple sclerosis. We present the reader with a brief review on the AHCT procedure, its immunomodulatory mechanism of action in MS, the most recent evidence in support of its use in patients with relapsing-remitting multiple sclerosis (RRMS), as well as its cost considerations. RECENT FINDINGS The first meta-analysis of clinical trials of AHCT for patients with MS demonstrated durable 5-year progression-free survival rates and low treatment-related mortality. Recently, the first randomized controlled phase III clinical trial demonstrated AHCT to be superior to best available therapy for a subset of patients with RRMS. This led to the American society for transplant and cellular therapies (ASTCT) to recommend AHCT "for patients with relapsing forms of MS who have prognostic factors that indicate a high risk of future disability." AHCT should be considered for patients with RRMS with evidence of clinical activity who have failed 2 lines of therapy or at least one highly active disease-modifying therapy.
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Affiliation(s)
- Anastasie M Dunn-Pirio
- Division of Neuroimmunology, Department of Neurosciences, UC San Diego, La Jolla, CA, 92093, USA
| | - Benjamin M Heyman
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center, UC San Diego, MC 0695, La Jolla, CA, 92093, USA.
| | - Dan S Kaufman
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center, UC San Diego, MC 0695, La Jolla, CA, 92093, USA
| | - Revere P Kinkel
- Division of Neuroimmunology, Department of Neurosciences, UC San Diego, La Jolla, CA, 92093, USA
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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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Bass AD, Van Wijmeersch B, Mayer L, Mäurer M, Boster A, Mandel M, Mitchell C, Sharrock K, Singer B. Effect of Multiple Sclerosis on Daily Activities, Emotional Well-being, and Relationships: The Global vsMS Survey. Int J MS Care 2019; 22:158-164. [PMID: 32863783 DOI: 10.7224/1537-2073.2018-087] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background The vsMS survey was conducted to better understand the negative effects of fatigue, cognitive impairment, emotional burden, and decreased physical functioning on the personal, professional, and social lives of individuals with multiple sclerosis (MS). Methods The vsMS survey was an online survey conducted in Australia, Canada, France, Italy, Spain, the United Kingdom, and the United States that assessed the impact of MS on individuals' daily activities, emotional well-being, relationships, and employment. Results The survey included 1075 participants with relapsing-remitting MS. Almost 42% of participants reported that their ability to perform and manage daily activities had worsened during the previous 2 years. More than 50% reported limitations in daily activities due to fatigue, physical weakness, problems with balance/coordination, heat/cold sensitivity, memory problems, numbness/tingling, trouble concentrating, impaired movement/muscle stiffness, and impaired sleeping. Participants also reported a negative effect on emotional and social factors, including self-esteem, general outlook, well-being, maintaining/starting relationships, ability to progress in their career/keep their job, and ability to cope with life roles. Conclusions These data highlight the importance of addressing the impact of MS and the social and emotional disease burdens on daily activities when planning the care of patients with MS.
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Gyllensten H, Kavaliunas A, Murley C, Alexanderson K, Hillert J, Tinghög P, Friberg E. Costs of illness progression for different multiple sclerosis phenotypes: a population-based study in Sweden. Mult Scler J Exp Transl Clin 2019; 5:2055217319858383. [PMID: 31285832 PMCID: PMC6600515 DOI: 10.1177/2055217319858383] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/15/2019] [Accepted: 05/26/2019] [Indexed: 11/30/2022] Open
Abstract
Background Little is known of how the cost of illness and health-related quality of life
changes over time after a diagnosis of multiple sclerosis. Objectives The aim was thus to explore the progression of annual direct and indirect
costs and health-related quality of life among people with multiple
sclerosis of working ages, following diagnosis with relapsing–remitting
multiple sclerosis (RRMS), primary progressive multiple sclerosis (PPMS) or
conversion to secondary progressive multiple sclerosis (SPMS) after
RRMS. Methods Swedish nationwide registers were linked to estimate the annual cost of
illness in 2006–2013 among people with a registered new multiple sclerosis
phenotype, including: direct costs, indirect costs, and health-related
quality of life. Results Drugs and indirect costs for sick leave were the main cost drivers after
diagnosis with RRMS. After conversion to SPMS, the RRMS cost drivers were
replaced by indirect costs for disability pension. The main cost driver in
newly diagnosed PPMS was indirect costs for sick leave, later replaced by
disability pension. Health-related quality of life scores were similar after
RRMS and SPMS. Conclusions After initial high indirect costs for sick leave, people with RRMS had higher
drug costs compared to people with PPMS. Cost drivers during SPMS initially
followed the pattern in the RRMS population, but were replaced by indirect
costs for disability pension.
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Affiliation(s)
- Hanna Gyllensten
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | | | - Chantelle Murley
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | | | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Petter Tinghög
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Emilie Friberg
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
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Alowayesh MS, Ahmed SF, Al-Hashel J, Alroughani R. Economic burden of multiple sclerosis on Kuwait health care system. PLoS One 2019; 14:e0216646. [PMID: 31086393 PMCID: PMC6516657 DOI: 10.1371/journal.pone.0216646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/26/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic neurological disease with heavy economic and social burdens resulting in significant disability. OBJECTIVE This study aims to (1) measure the cost of health resources utilization by MS patients and (2) to examine the difference in utilization and its attributed costs amongst patients who may have a different course of MS and expanded disability status scale (EDSS) scores. METHODS A cross-sectional study using Kuwait National MS registry was conducted to estimate the costs of utilization of resources from 2011 to 2015. RESULTS Between the period 2011-2015, 1344 MS patients were included in the registry. The average annual cost per MS patient has increased from $10,271 in 2011 to $17,296 in 2015. Utilization of disease-modifying therapies (DMTs) was the main driver of costs reaching 89.9% in 2015. Throughout the five-year period, the occurrence of relapses decreased from 21.8% to 12.2% (p <0.0001). During this same period, ambulatory relapse treatment increased by 5.8% while hospitalizations decreased by 2.6%. Patients with a moderate EDSS score (3.5-6) had the highest average cost (p<0.0001) compared to mild and severe EDSS scores. CONCLUSIONS Multiple sclerosis has been a significant economic burden on the Kuwait healthcare system. DMTs are the main driver of cost.
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Affiliation(s)
- Maryam S. Alowayesh
- Department of Pharmacy Practice, School of Pharmacy, Kuwait University, Jabriya, Kuwait
| | - Samar F. Ahmed
- Department of Neurology, Ibn Sina Hospital, Sabah Medical Area, Kuwait
- Department of Neurology and Psychiatry, Minia University, Minia, Egypt
| | - Jasem Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Sabah Medical Area, Kuwait
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
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