Nicholas Richard S, Heaven Martin L, Middleton Rodden M, Chevli Manoj, Pulikottil-Jacob Ruth, Jones Kerina H, Ford David V
Faculty of Medicine, Imperial College London, United Kingdom.
Swansea University Medical School, United Kingdom.
Mult Scler J Exp Transl Clin. 2020 Jan 22;6(1):2055217320901727. doi: 10.1177/2055217320901727. eCollection 2020 Jan-Mar.
To investigate through survey and data linkage, healthcare resource use and costs (except drugs), including who bears the cost, of multiple sclerosis in the United Kingdom by disease severity and type.
The United Kingdom Multiple Sclerosis Register deployed a cost of illness survey, completed by people with multiple sclerosis and linked this with data within the United Kingdom Multiple Sclerosis Register and from their hospital records. Resource consumption was categorised as being medical or non-medical and costed by National Health Service and social services estimates for 2018.
We calculated £509,003 in non-medical costs over a year and £435,488 in medical costs generated over 3 months. People with multiple sclerosis reported self-funding 75% of non-medical costs with non-medical interventions having long-term potential benefits. Costs increased with disability as measured by patient-reported Expanded Disability Status Score and Multiple Sclerosis Impact Scale, with Multiple Sclerosis Impact Scale physical being a more powerful predictor of costs than the patient-reported Expanded Disability Status Score. Two distinct groups were identified: medical and non-medical interventions ( = 138); and medical interventions only ( = 399). The medical and non-medical group reported increased disease severity and reduced employment but incurred 80% more medical costs per person than the medical-only group.
The importance of disability in driving costs is illustrated with balance between medical and non-medical costs consistent with the United Kingdom health environment. People with multiple sclerosis and their families fund a considerable proportion of non-medical costs but non-medical interventions with longer term impact could affect future medical costs.
通过调查和数据关联，按疾病严重程度和类型，研究英国多发性硬化症的医疗资源使用情况和成本（不包括药物），包括成本由谁承担。
英国多发性硬化症登记处开展了一项疾病成本调查，由多发性硬化症患者完成，并将其与英国多发性硬化症登记处的数据及其医院记录相关联。资源消耗分为医疗或非医疗类别，并根据2018年国民保健服务和社会服务估计进行成本核算。
我们计算出一年的非医疗成本为509,003英镑，三个月产生的医疗成本为435,488英镑。多发性硬化症患者报告称，他们自掏腰包承担了75%的非医疗成本，非医疗干预具有长期潜在益处。成本随着患者报告的扩展残疾状态评分和多发性硬化症影响量表所衡量的残疾程度增加而增加，其中多发性硬化症影响量表身体部分比患者报告的扩展残疾状态评分更能有力地预测成本。确定了两个不同的组：医疗和非医疗干预组（n = 138）；以及仅医疗干预组（n = 399）。医疗和非医疗组报告疾病严重程度增加且就业减少，但每人产生的医疗成本比仅医疗组多80%。
残疾对成本的驱动作用得到体现，医疗成本和非医疗成本之间的平衡与英国的健康环境一致。多发性硬化症患者及其家庭承担了相当比例的非医疗成本，但具有长期影响的非医疗干预可能会影响未来的医疗成本。
