Kobelt Gisela, Berg Jenny, Lindgren Peter, Elias W G, Flachenecker P, Freidel M, König N, Limmroth V, Straube E
Lund University, Lund, Sweden.
Eur J Health Econ. 2006 Sep;7 Suppl 2:S34-44. doi: 10.1007/s10198-006-0384-8.
This cost-of-illness analysis based on information from 2973 patients with multiple sclerosis (MS) in Germany is part of a Europe-wide study on the costs of MS. The objective was to analyze the costs and quality of life (QOL) related to the level of disease severity. Patients from six centres (office- and hospital-based physicians) and patients enrolled in a database were asked to participate in the survey; 38% answered a mail questionnaire. In addition to details on the disease (type of disease, relapses, level of functional disability), the questionnaire asked for information on all resource consumption, medical, non-medical, work absence, informal care, as well as QOL (measured as utility). The mean age of the cohort was 45 years, and 18% of patients were 65 years of age or older. Forty-seven percent of patients had mild disease (Expanded Disability Status Scale [EDSS] score 0-3), 36% had moderate disease (EDSS score 4-6.5) and 12% had severe disease (EDSS score > or =7). The mean EDSS score in the sample was 3.8 (median 4.0), with a mean utility of 0.62. Costs and utility are highly correlated with disease severity. Workforce participation decreases from 73% in very early disease to less than 10% in the very late stages, leading to a tenfold rise in productivity losses in the late stages of disease. Hospitalisation and ambulatory visits rise by a factor of 5-6 between early and late disease; investments and services increase from basically no cost to euro 2700; and informal care increases by a factor of 27 for patients with an EDSS score of 7 and by a factor of 50 for patients at the very severe end of the EDSS scale (8-9). Hence, total mean costs per patient are determined essentially by the distribution of the severity levels in the sample, increasing from approximately euro 18 500 at an EDSS score of 0-1 to euro 70 500 at an EDSS score of 8-9. The same is true for utility, which decreases from 0.86 to 0.10 as the disease becomes severe. However, the utility loss compared to the general population is high at all levels of the disease, leading to an estimated loss of 0.2 quality-adjusted life-years per patient. Relapses are associated with a cost of approximately euro 3 000 and a utility loss of 0.1 during the quarter in which they occur. Compared with a similar study performed in 1999, resource consumption, with the exception of drugs, is somewhat lower. This is most likely due to a difference in the severity distribution of the two samples and to changes in health-care consumption overall in the country, such as the introduction of diagnosis-related groups (DRGs, Fallpauschalen).
这项基于德国2973例多发性硬化症（MS）患者信息的疾病成本分析，是一项全欧洲范围内MS疾病成本研究的一部分。其目的是分析与疾病严重程度相关的成本和生活质量（QOL）。来自六个中心（门诊和住院医生）的患者以及纳入数据库的患者被邀请参与调查；38%的患者回复了邮寄问卷。除了疾病细节（疾病类型、复发情况、功能残疾程度）外，问卷还询问了所有资源消耗情况，包括医疗、非医疗、缺勤、非正式护理以及QOL（以效用衡量）。该队列的平均年龄为45岁，18%的患者年龄在65岁及以上。47%的患者疾病较轻（扩展残疾状态量表[EDSS]评分0 - 3），36%的患者疾病中度（EDSS评分4 - 6.5），12%的患者疾病严重（EDSS评分≥7）。样本中的平均EDSS评分为3.8（中位数为4.0），平均效用为0.62。成本和效用与疾病严重程度高度相关。劳动力参与率从疾病极早期的73%下降到疾病极晚期的不到10%，导致疾病晚期生产力损失增加了10倍。从疾病早期到晚期，住院和门诊就诊次数增加了5 - 6倍；投资和服务从基本无成本增加到2700欧元；对于EDSS评分为7的患者，非正式护理增加了27倍，对于EDSS量表最严重端（8 - 9）的患者，非正式护理增加了50倍。因此，每位患者的总平均成本基本上由样本中严重程度水平的分布决定，从EDSS评分为0 - 1时的约18500欧元增加到EDSS评分为8 - 9时的70500欧元。效用情况也是如此，随着疾病变得严重，效用从0.86下降到0.10。然而，在疾病的所有阶段，与一般人群相比，效用损失都很高，导致估计每位患者损失0.2个质量调整生命年。复发在发生的季度会带来约3000欧元的成本和0.1的效用损失。与1999年进行的类似研究相比，除药物外的资源消耗有所降低。这很可能是由于两个样本的严重程度分布不同以及该国总体医疗保健消费的变化，如引入诊断相关分组（DRGs，病种费用包干）。
