Berg Jenny, Lindgren P, Fredrikson Sten, Kobelt Gisela
Stockholm Health Economics, Stockholm, Sweden.
Eur J Health Econ. 2006 Sep;7 Suppl 2:S75-85. doi: 10.1007/s10198-006-0379-5.
The study objective was to analyse the costs and quality of life (QOL) of multiple sclerosis (MS) related to disease severity in Sweden as part of a study in nine European countries. Information on demographics, disease, resource utilisation, informal care needs, work capacity and QOL (utility) was collected using a questionnaire that was sent to patients registered with the Swedish organisation of patients with neurological disabilities (Neurologiskt Handikappades Riksförbund). The study used a prevalence-based and cross-sectional approach, and costs were estimated from a societal perspective. A total of 1,339 patients were included in the analysis. Seventy-three percent of patients were female, and the mean age was 53 years (standard deviation [SD], 12 years). The mean Expanded Disability Status Scale (EDSS) score was 5.1 (SD, 2.2); only 29% of patients had mild disease (EDSS score <4), 46% had moderate disease and 25% had severe disease (EDSS score > or =7). Costs were significantly correlated with disease severity, increasing sevenfold from around euro 16.000 at EDSS scores of 0-1 to euro 116.000 at EDSS scores of 8-9. At the same time, utility decreased with worsening disease from 0.825 to 0.047, with a mean established at 0.546 (SD, 0.287). This is significantly lower than utilities for an age- and gender-matched sample of the general population, which would be estimated at 0.80-0.85. Patients with a relapse during the last 3 months had a significant cost increase, of euro 3.080, and a utility loss of 0.088. Costs and utilities are highly correlated with EDSS score, and the mean cost per patient in the sample is thus heavily influenced by the severity distribution in the sample. Compared to European estimates, patients with moderate and severe disease in our sample appear to be overrepresented, and costs can therefore not be directly extrapolated to the overall MS population in Sweden without adjustment. When correcting for estimated actual prevalence and use of disease modifying drugs (DMDs), the total cost of MS in Sweden is estimated at euro 600 million. Compared to an earlier cost study in 1998 that included a similar sample, and adjusting for differential timing and estimated national use of DMDs, costs have increased by approximately 5% between 1998 and 2005.
作为一项在9个欧洲国家开展的研究的一部分，本研究的目的是分析瑞典多发性硬化症（MS）患者的成本及生活质量（QOL）与疾病严重程度之间的关系。通过向在瑞典神经残疾患者组织（Neurologiskt Handikappades Riksförbund）登记的患者发送调查问卷，收集了有关人口统计学、疾病、资源利用、非正式护理需求、工作能力和生活质量（效用）的信息。本研究采用基于患病率的横断面研究方法，并从社会角度估算成本。共有1339名患者纳入分析。73%的患者为女性，平均年龄为53岁（标准差[SD]为12岁）。扩展残疾状态量表（EDSS）的平均评分为5.1（SD为2.2）；只有29%的患者患有轻度疾病（EDSS评分<4），46%患有中度疾病，25%患有重度疾病（EDSS评分>或=7）。成本与疾病严重程度显著相关，从EDSS评分为0 - 1时的约16000欧元增加到EDSS评分为8 - 9时的116000欧元，增长了7倍。与此同时，随着疾病恶化，效用从0.825降至0.047，平均为0.546（SD为0.287）。这显著低于年龄和性别匹配的普通人群样本的效用估计值，后者估计为0.80 - 0.85。在过去3个月内有复发的患者成本显著增加，增加了3080欧元，效用损失为0.088。成本和效用与EDSS评分高度相关，因此样本中每位患者的平均成本受样本中严重程度分布的影响很大。与欧洲的估计值相比，我们样本中的中度和重度疾病患者似乎占比过高，因此在未经调整的情况下，成本不能直接外推至瑞典的整体MS患者群体。在对估计的实际患病率和疾病修饰药物（DMD）的使用进行校正后，瑞典MS的总成本估计为6亿欧元。与1998年一项纳入类似样本的早期成本研究相比，并对不同时间点和估计的全国DMD使用情况进行调整后，1998年至2005年间成本增加了约5%。
