Groupe d'analyse, Ltée, Montréal, QC, Canada.
J Neurol Sci. 2013 Jul 15;330(1-2):71-7. doi: 10.1016/j.jns.2013.04.007. Epub 2013 May 3.
MS relapses are unpredictable and can be concerning to patients and their caregivers.
To assess the direct and indirect cost burden associated with relapses of different severities in MS patients and with MS relapse frequency on spouse caregivers.
Using a U.S. insurance claims and employee disability database (1999-2011), we studied adult MS patients (ICD-9-CM: 340.x) and their spouse caregivers. A previously published algorithm to identify relapses was used to stratify: (1) MS patients into cohorts of no, low/moderate, and high severity relapse based on the most severe relapse within one year of follow-up (if any); (2) caregivers into cohorts of no, less, and more frequent relapses based on the overall frequency of relapses of their spouse. Adjusted cost differences and 95% confidence intervals evaluating the yearly incremental costs at 12 months of follow-up (MS patients) and overall (caregivers) associated with relapses are reported.
Among the 9421 MS patients (N: no relapse=7686; low/moderate severity relapse=1220; high severity relapse=515) identified, both relapse cohorts incurred significantly higher annual incremental direct costs than the no relapse cohort (low/moderate severity=$8269 [6565-10,115]; high severity=$24,180 [20,263-28,482]) and indirect costs (low/moderate severity=$1429 [759-2147]; high severity=$2714 [1468-4035]). More frequent relapses versus no relapse also translated into a significantly greater cost burden for caregivers (direct+indirect=$1725 [376-2885]) but less frequent relapses did not.
Relapse severity was significantly and increasingly associated with greater direct and indirect costs in MS patients. More frequent relapses also translated into a significant cost burden in spouse caregivers.
多发性硬化症（MS）的复发是不可预测的，这会让患者及其护理人员感到担忧。
评估不同严重程度的 MS 患者复发以及患者复发频率对配偶护理人员带来的直接和间接经济负担。
我们使用了美国的保险索赔和员工残疾数据库（1999-2011 年），研究了成年 MS 患者（ICD-9-CM 编码：340.x）及其配偶护理人员。我们使用了一种已发表的算法来识别复发，该算法将 MS 患者分为无复发、低/中度复发和高复发严重程度的队列，这是基于在随访一年内最严重的复发情况（如果有的话）；根据配偶的总体复发频率，将护理人员分为无复发、复发较少和复发更频繁的队列。报告了在 12 个月的随访（MS 患者）和总体（护理人员）时，与复发相关的调整后成本差异和 95%置信区间，以评估每年的增量成本。
在确定的 9421 名 MS 患者（无复发者=7686 例；低/中度严重程度复发者=1220 例；高严重程度复发者=515 例）中，复发队列的年度增量直接成本均显著高于无复发队列（低/中度严重程度复发者为 8269 美元[6565 美元至 10115 美元]；高严重程度复发者为 24180 美元[20263 美元至 28482 美元]）和间接成本（低/中度严重程度复发者为 1429 美元[759 美元至 2147 美元]；高严重程度复发者为 2714 美元[1468 美元至 4035 美元]）。与无复发相比，更频繁的复发也给配偶护理人员带来了更大的经济负担（直接加间接费用=1725 美元[376 美元至 2885 美元]），但不太频繁的复发则不会。
复发的严重程度与 MS 患者的直接和间接成本显著增加相关。更频繁的复发也给配偶护理人员带来了显著的经济负担。
