Predictors of the 10‐year direct costs for treating multiple sclerosis

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Multiple sclerosis (MS) is an important cause of significant physical disability among young adults in Western countries, with considerable social impact and economic burden, as a result of the difficulties in activities of daily living, and of the use of disease‐modifying treatments (DMTs) with their multidisciplinary management.1 To be more precise, DMTs constitute the largest direct medical cost,4 and need to be administered for long periods in order to obtain positive effects on the MS population, with a reduction of attacks and of progressive disability accrual, possibly also decreasing the overall social,and economic impact of MS over time.6
In view of this, over the past 20 years, economic analyses of MS treatments have received much attention in health policy contexts. Most economic investigations are retrospective resource‐utilization studies based on patients’ self‐completed surveys.3 However, these studies can be biased by a significant recall error, or by more severe MS patients, being prompted in participating with their experiences. Furthermore, there is a considerable range in the estimates due to the heterogeneity in the methodology used for data collection, and in the selection of resource use.11 Nevertheless, other investigations focused on cost‐effectiveness of treatments for MS, but reported sparse and uncertain results.12 In fact, some studies have evaluated costs of DMTs at the level of cost‐effectiveness thresholds, whereas others have estimated their costs well beyond the healthcare system tolerance.1 Moreover, the rapidly changing treatment landscape with newer and more expensive DMTs is an additional motivation to further develop analyses that are relevant for clinicians and healthcare system decision‐makers, also by including real‐world scenarios.14
Eventually, the high costs for DMT administration and management can noticeably affect health policies for MS,15 and thus, the identification of early predictors for the future economic burden of MS treatment might be particularly helpful in programming the healthcare assistance. However, previous economic studies in MS presented a cross‐sectional design, or were limited to a short period (usually below 2 years), and, so, were unable to investigate possible predictors of the long‐term expenditure.12 Noteworthy, longitudinal clinical studies found different predictors of a more aggressive disease evolution (i.e. older age, higher relapse frequency, reaching of specific milestone of disease evolution),17 that might be also associated with costs for treating MS. In view of this, the present real‐world study investigated demographic and clinical predictors of the 10‐year costs for DMT administration and management among newly diagnosed, drug naïve relapsing–remitting MS (RRMS) patients. Therefore, this study design considered the costs as being the outcome of the analyses, while demographic and clinical features were used to predict the economic burden, in order to connect physician perspectives with the point of view of the healthcare system, ultimately establishing the amount of resources needed for people with MS.

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