OBJECTIVES:

Poor specific information on economic burden of Multiple Sclerosis (MS) phenotypes are available. This study assessed the costs associated to the main MS phenotypes: relapsing remitting (RRMS), secondary progressive (SPMS) and primary progressive (PPMS).

METHODS:

Patients covered by Lombardy Healthcare System with a diagnosis of MS in the period 2004-2010 were identified through regional healthcare administrative databases. Data extracted from these databases were linked with clinical information collected by a major MS center in Lombardy, and for each patient we identified the MS phenotype and diseases severity assessed with the Expanded Disability Status Scale (EDSS). We identified drug prescriptions, hospitalizations, outpatient visits and diagnostic tests provided to patients for their MS during the years after the identification. We estimated the health care resources consumption and the mean annual cost per capita stratified by EDSS level and MS phenotype.

RESULTS:

The study identified 871 patients with a mean age of 37.9 years. At start of observation, 83.9% reported RRMS, 8.5% SPMS and 7.2% PPMS. More than 8% of RRMS developed SPMS during observational period. RRMS reported the highest annual cost per patient with a mean of € 7,136 in patients with EDSS level 0-3, €9,820 with EDSS level 4-6 and €11,569 with EDSS level 7-9. The PPMS patients reported the lower annual mean cost per patient (€ 2,261 EDSS 0-3, €3,920 EDSS 4-6, and €8,290 EDSS 7-9). The higher cost of RRMS patients was mainly due to the use of disease modifying therapies (DMTs), with a low impact associated to relapse cost (€405 per relapse). The RRMS patients treated with DMTs reported a treatment switch rate of 12.1 per 100 person-years.

CONCLUSIONS:

Costs were highly correlated with disease severity and MS phenotype. These data can help health care decision-maker to better assess the burden of MS pheotypes and the possible impact of DMTs.