Kobelt Gisela, Berg Jenny, Lindgren P, Kerrigan J, Russell N, Nixon R
Lund University, Lund, Sweden.
Eur J Health Econ. 2006 Sep;7 Suppl 2:S96-104. doi: 10.1007/s10198-006-0380-z.
This cost-of-illness analysis for the United Kingdom is part of a Europe-wide study on the costs of multiple sclerosis (MS). The objective was to analyze the costs and quality of life (utility) related to the level of disease severity. People with MS from a database administered by a UK charity (the MS Trust) were asked to participate in the survey by answering a postal 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 and informal care as well as utility. The response rate was 19%, and a total of 2048 people were included. The mean age of the cohort was 51 years, and 23% of people were > or =60 years of age. Disease severity was concentrated in people with moderately severe MS (Expanded Disability Status Scale [EDSS] score of 4 to 6.5), with 21, 60 and 19% of people reporting mild, moderate and severe disease, respectively. Costs and utility are highly correlated with disease severity. Mean annual costs for all people in the study increase from approximately pound 12.000 at an EDSS score <4 to almost pound 60.000 at an EDSS score > or =7. In particular, employment rates are reduced from 82% in early disease to 2% at an EDSS score of 8, while the costs of inpatient care, investments, informal care and productivity losses increase by more than tenfold between an EDSS score of 0-1 and a score > or =7. Utility decreases from 0.92 at an EDSS score of 0 to a state worse than death in the most severe state (-0.18 at an EDSS score of 9). Compared to the results in an earlier cost study in the United Kingdom using a comparable methodology, costs have substantially increased, by roughly 40%. Part of the increase is due to a higher use of disease-modifying drugs and, possibly linked with this, a higher use of ambulatory care and services. Another part of the increase is most likely due to an increased age in the current sample, with more patients on early retirement due to MS and more intense use of informal care. However, another reason may lie in the methodology, e.g. different unit costs or differences in the sample distribution, despite a similar mean EDSS score of 5.1.
这项针对英国的疾病成本分析是一项全欧洲范围内关于多发性硬化症（MS）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（效用）。来自英国一家慈善机构（MS信托基金）管理数据库中的MS患者被要求通过回复邮寄问卷参与调查。除了疾病详情（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、缺勤和非正式护理以及效用方面的信息。回复率为19%，共纳入2048人。该队列的平均年龄为51岁，23%的人年龄≥60岁。疾病严重程度集中在中度严重的MS患者中（扩展残疾状态量表[EDSS]评分为4至6.5），分别有21%、60%和19%的人报告病情为轻度、中度和重度。成本和效用与疾病严重程度高度相关。研究中所有患者的年均成本从EDSS评分<4时的约12000英镑增加到EDSS评分≥7时的近60000英镑。特别是，就业率从疾病早期的82%降至EDSS评分为8时的2%，而住院护理、投资、非正式护理和生产力损失的成本在EDSS评分从0 - 1到≥7之间增加了十倍以上。效用从EDSS评分为0时的0.92降至最严重状态下比死亡更糟的状态（EDSS评分为9时为 - 0.18）。与英国早期一项采用类似方法的成本研究结果相比，成本大幅增加，约40%。成本增加的部分原因是疾病修正药物的使用增加，可能与此相关的是门诊护理和服务的使用增加。成本增加的另一部分很可能是由于当前样本中年龄增长，有更多因MS提前退休的患者以及非正式护理的使用更加密集。然而，另一个原因可能在于方法学，例如尽管平均EDSS评分为5.1，但单位成本不同或样本分布存在差异。
