治疗复发型多发性硬化症的医疗费用及疾病进展风险：一项2001年至2015年的意大利回顾性队列研究。
Healthcare Costs for Treating Relapsing Multiple Sclerosis and the Risk of Progression: A Retrospective Italian Cohort Study from 2001 to 2015.
作者信息
Moccia Marcello, Palladino Raffaele, Lanzillo Roberta, Carotenuto Antonio, Russo Cinzia Valeria, Triassi Maria, Brescia Morra Vincenzo
机构信息
Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy.
Department of Primary Care and Public Health, Imperial College, London, United Kingdom.
出版信息
PLoS One. 2017 Jan 5;12(1):e0169489. doi: 10.1371/journal.pone.0169489. eCollection 2017.
BACKGROUND
Disease modifying treatments (DMTs) are the main responsible for direct medical costs in multiple sclerosis (MS). The current investigation aims at evaluating possible associations between healthcare costs for treating relapsing remitting MS (RRMS) and disease evolution.
METHODS
The present cohort study retrospectively included 544 newly diagnosed RRMS patients, prospectively followed up for 10.1±3.3 years. Costs for DMT administration and management were calculated for each year of observation. Following clinical endpoints were recorded: time to first relapse, 1-point EDSS progression, reaching of EDSS 4.0, reaching of EDSS 6.0, and conversion to secondary progressive MS (SP). Covariates for statistical analyses were age, gender, disease duration and EDSS at diagnosis.
RESULTS
At time varying Cox regression models, 10% increase in annual healthcare costs was associated with 1.1% reduction in 1-point EDSS progression (HR = 0.897; p = 0.018), with 0.7% reduction in reaching EDSS 6.0 (HR = 0.925; p = 0.030), and with 1.0% reduction in SP conversion (HR = 0.902; p = 0.006).
CONCLUSION
Higher healthcare costs for treating MS have been associated with a milder disease evolution after 10 years, with possible reduction of long-term non-medical direct and indirect costs.
背景
疾病修正治疗（DMTs）是多发性硬化症（MS）直接医疗费用的主要承担者。本研究旨在评估复发缓解型多发性硬化症（RRMS）的治疗费用与疾病进展之间的可能关联。
方法
本队列研究回顾性纳入了544例新诊断的RRMS患者，前瞻性随访10.1±3.3年。计算观察期内每年DMT给药和管理的费用。记录以下临床终点：首次复发时间、扩展残疾状态量表（EDSS）进展1分、EDSS达到4.0、EDSS达到6.0以及转化为继发进展型多发性硬化症（SP）。统计分析的协变量为年龄、性别、疾病持续时间和诊断时的EDSS。
结果
在时变Cox回归模型中，年度医疗费用增加10%与EDSS进展1分减少1.1%相关（风险比[HR]=0.897；p=0.018），与EDSS达到6.0减少0.7%相关（HR=0.925；p=0.030），与SP转化减少1.0%相关（HR=0.902；p=0.006）。
结论
治疗MS的较高医疗费用与10年后较轻的疾病进展相关，可能会降低长期非医疗直接和间接费用。
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