MS Center, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany.
Novartis Pharma GmbH, Nuremberg, Germany.
Pharmacoeconomics. 2020 Aug;38(8):883-892. doi: 10.1007/s40273-020-00917-3.
Relapses are the hallmark of multiple sclerosis (MS). Analyses have shown that the cost of MS increases during periods of relapse. However, results are inconsistent between studies, possibly due to different study designs and the different implications of relapses with respect to patient characteristics.
The aims were to estimate and describe direct and indirect relapse costs and to determine differences in costs with respect to patient characteristics. Furthermore, we describe the pharmacoeconomic impact during the relapse follow-up.
Data were extracted from two German, multicenter, observational studies applying a validated resource costs instrument. Relapse costs were calculated as the difference in quarterly costs between propensity score (PS)-matched patients with and without relapses (1:1 ratio). For relapse active patients, we additionally calculated the difference between quarterly costs prior to and during relapse and determined costs in the post-relapse quarter.
Of 1882 patients, 607 (32%) presented at least one relapse. After PS-matching, 597 relapse active and relapse inactive patients were retained. Relapse costs (in 2019 values) ranged between €791 (age 50 + years) and €1910 (disease duration < 5 years). In mildly disabled and recently diagnosed patients, indirect relapse costs (range €1073-€1207) constantly outweighed direct costs (range €591-€703). The increase from prior quarter to relapse quarter was strongest for inpatient stays (+ 366%, €432; p < 0.001), day admissions (+ 228%, €57; p < 0.001), and absenteeism (127%, €463; p < 0.001). In the post-relapse quarter, direct costs and costs of absenteeism remained elevated for patients with relapse-associated worsening.
A recent diagnosis and mild disability lead to high relapse costs. The results suggest the necessity to incorporate patient characteristics when assessing relapse costs.
复发是多发性硬化症（MS）的标志。分析表明，在复发期间，MS 的成本会增加。然而，由于研究设计不同以及复发对患者特征的不同影响，研究结果之间存在不一致。
旨在估计和描述复发的直接和间接成本，并确定与患者特征相关的成本差异。此外，我们还描述了复发随访期间的药物经济学影响。
从两项德国多中心观察性研究中提取数据，这些研究使用了经过验证的资源成本工具。复发成本是通过比较具有和不具有复发的倾向评分（PS）匹配患者（1:1 比例）的季度成本差异来计算的。对于复发活跃的患者，我们还计算了复发前后季度成本的差异，并确定了复发后季度的成本。
在 1882 名患者中，有 607 名（32%）至少出现了一次复发。经过 PS 匹配后，保留了 597 名复发活跃和复发不活跃的患者。复发成本（以 2019 年的价值计算）在€791（年龄 50+岁）和€1910（病程<5 年）之间。在轻度残疾和近期诊断的患者中，间接复发成本（范围€1073-€1207）始终超过直接成本（范围€591-€703）。从前期季度到复发季度的增幅最大的是住院治疗（增加 366%，€432；p<0.001）、日间入院（增加 228%，€57；p<0.001）和旷工（增加 127%，€463；p<0.001）。在复发后季度，与复发相关的病情恶化的患者的直接成本和旷工成本仍然较高。
最近的诊断和轻度残疾导致较高的复发成本。结果表明，在评估复发成本时，有必要考虑患者特征。
