Health Economics, Global Market Access Solutions Sarl, St-Prex, Switzerland.
Department of Economics, University of Athens, Athens, Greece.
J Med Econ. 2020 Aug;23(8):831-837. doi: 10.1080/13696998.2020.1757457. Epub 2020 May 13.
The economic consequences of multiple sclerosis (MS) are broader than those observed within the health system. The progressive nature suggests that people will not be able to live a normal productive life and will gradually require public benefits to maintain living standards. This study investigates the public economic impact of MS and how investments in disease-modifying therapies (DMTs) influence the lifetime costs to government attributed to changes in lifetime tax revenue and disability benefits based on improved health status linked to delayed disease progression. Disease progression rates from previous MS Markov cohort models were applied to interferon beta-1a, peginterferon beta-1a, dimethyl fumarate, and natalizumab using a public economic framework. The established relationship between expanded disability status scale and work-force participation, annual earnings, and disability rates for each DMT were applied. Subsequently, we assessed the effect of DMTs on discounted governmental costs consisting of health service costs, social insurance and disability costs, and changes in lifetime tax revenues. Fiscal benefits attributed to informal care and community services savings for interferon beta-1a, peginterferon beta-1a, dimethyl fumarate, and natalizumab were SEK340,387, SEK486,837, SEK257,330, and SEK958,852 compared to placebo, respectively. Tax revenue gains linked to changes in lifetime productivity for interferon beta-1a, peginterferon beta-1a, dimethyl fumarate, and natalizumab were estimated to be SEK27,474, SEK39,659, SEK21,661, and SEK75,809, with combined fiscal benefits of cost savings and tax revenue increases of SEK410,039, SEK596,592, SEK326,939, and SEK1,208,023, respectively. The analysis described here illustrates the broader public economic benefits for government attributed to changes in disease status. The lifetime social insurance transfer costs were highest in non-treated patients, and lower social insurance costs were demonstrated with DMTs. These findings suggest that focusing cost-effectiveness analysis only on health costs will likely underestimate the value of DMTs.
多发性硬化症（MS）的经济后果超出了卫生系统所观察到的范围。其进行性特征表明，患者将无法过上正常的生产生活，并且将逐渐需要公共福利来维持生活水平。本研究调查了 MS 的公共经济影响，以及基于与疾病进展延迟相关的健康状况改善而导致的终生税收和残疾福利变化，疾病修饰疗法（DMT）投资如何影响政府归因于终生成本。使用公共经济框架，将先前的 MS 马尔可夫队列模型中的疾病进展率应用于干扰素 beta-1a、聚乙二醇干扰素 beta-1a、二甲基富马酸和那他珠单抗。将扩展残疾状态量表与每种 DMT 的劳动力参与率、年收益和残疾率之间的关系应用于该模型。随后，我们评估了 DMT 对由卫生服务成本、社会保险和残疾成本以及终生税收变化组成的政府贴现成本的影响。与安慰剂相比，干扰素 beta-1a、聚乙二醇干扰素 beta-1a、二甲基富马酸和那他珠单抗分别节省了 340387 瑞典克朗、486837 瑞典克朗、257330 瑞典克朗和 958852 瑞典克朗的非正式护理和社区服务节省费用。干扰素 beta-1a、聚乙二醇干扰素 beta-1a、二甲基富马酸和那他珠单抗的终生生产力变化导致的税收收益估计分别为 27474 瑞典克朗、39659 瑞典克朗、21661 瑞典克朗和 75809 瑞典克朗，成本节约和税收收益增加的综合财政收益分别为 410039 瑞典克朗、596592 瑞典克朗、326939 瑞典克朗和 1208023 瑞典克朗。此处描述的分析说明了政府归因于疾病状态变化的更广泛的公共经济效益。在未治疗的患者中，终生社会保险转移成本最高，而 DMT 则降低了社会保险成本。这些发现表明，仅关注健康成本的成本效益分析可能会低估 DMT 的价值。
