Schriefer Dirk, Ness Nils-Henning, Haase Rocco, Ziemssen Tjalf
MS Center Dresden, Center of Clinical Neuroscience, Neurological University Clinic Dresden, Germany.
Department of Neurology, MS Center Dresden, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Fetscherstr. 74, Dresden, 01307, Germany.
Ther Adv Neurol Disord. 2020 Oct 24;13:1756286420960274. doi: 10.1177/1756286420960274. eCollection 2020.
For the case of multiple sclerosis, research on gender differences from a health economics perspective has not received much attention. However, cost-of-illness analyses can provide valuable information about the diverse impact of the disease and thus help decision-makers to allocate scarce resources. The aim of this study was to describe healthcare resource use and associated societal costs from a gender perspective. In particular, we aimed to identify how resource utilization potentially differs in certain cost components between men and women.
Clinical and economic data were extracted from two prospective, multicentre, non-interventional, observational studies in Germany. Information on health resource use was obtained from all patients on a quarterly basis using a validated questionnaire.Cost analyses were conducted from the societal perspective including all direct (healthcare-related) and indirect (work-related) costs, regardless of who bears them. Gender-related differences were analysed by a multivariable generalized linear model with a negative binomial distribution and log link function due to the right-skewed distribution pattern of cost data. In addition, costs for men and women were descriptively analysed within subgroups of two-year disease activity.
In total, 2095 patients (women-to-men ratio of 2.7:1) presented a mean age of 41.85 years and a median Expanded Disability Status Scale of 2 (interquartile range 1-3.5) ( > 0.30 for gender-related differences). Women and men did not statistically differ in total quarterly costs (€2329 ± €2570 €2361 ± €2612). For both, costs were higher with advancing disease severity and indirect costs were the main societal cost driver. Regarding healthcare-related resources, women incurred higher costs for ambulant consultations [incidence rate ratio (IRR) 1.16, confidence interval (CI) 1.04-1.31], complementary medicine (IRR 2.41, CI 1.14-5.06), medical consumables (IRR 2.53, CI 1.69-3.79) and informal care (IRR 2.79, CI 1.56-5.01). Among indirect costs, we found higher costs for men for presenteeism (IRR 0.62; CI 0.53-0.72) and higher costs for women for disability pension (IRR 1.62; CI 1.23-2.13).
Multiple sclerosis poses a significant economic burden on patients, families and society. While the total economic burden did not differ between male and female patients, we found gender differences in specific cost items that are similar to those in the wider non-MS population.
对于多发性硬化症，从卫生经济学角度对性别差异的研究尚未受到太多关注。然而，疾病成本分析可以提供有关该疾病不同影响的有价值信息，从而帮助决策者分配稀缺资源。本研究的目的是从性别角度描述医疗资源的使用情况及相关的社会成本。特别是，我们旨在确定男性和女性在某些成本组成部分中的资源利用可能存在的差异。
从德国两项前瞻性、多中心、非干预性观察性研究中提取临床和经济数据。使用经过验证的问卷每季度从所有患者那里获取健康资源使用信息。从社会角度进行成本分析，包括所有直接（与医疗保健相关）和间接（与工作相关）成本，无论由谁承担这些成本。由于成本数据呈右偏态分布模式，通过具有负二项分布和对数链接函数的多变量广义线性模型分析性别相关差异。此外，在两年疾病活动亚组中对男性和女性的成本进行了描述性分析。
总共2095名患者（女性与男性比例为2.7:1），平均年龄为41.85岁，扩展残疾状态量表中位数为2（四分位间距1 - 3.5）（性别相关差异>0.30）。男性和女性的季度总成本在统计学上没有差异（2329欧元±2570欧元对2361欧元±2612欧元）。对于两者而言，随着疾病严重程度的增加成本更高，间接成本是主要的社会成本驱动因素。在与医疗保健相关的资源方面，女性在门诊咨询（发病率比[IRR] 1.16，置信区间[CI] 1.04 - 1.31）、补充医学（IRR 2.41，CI 1.14 - 5.06）、医疗耗材（IRR 2.53，CI 1.69 - 并在两年疾病活动亚组中对男性和女性的成本进行了描述性分析。
总共2095名患者（女性与男性比例为2.7:1），平均年龄为41.85岁，扩展残疾状态量表中位数为2（四分位间距1 - 3.5）（性别相关差异>0.30）。男性和女性的季度总成本在统计学上没有差异（2329欧元±2570欧元对2361欧元±2612欧元）。对于两者而言，随着疾病严重程度的增加成本更高，间接成本是主要的社会成本驱动因素。在与医疗保健相关的资源方面，女性在门诊咨询（发病率比[IRR] 1.16，置信区间[CI] 1.04 - 1.31）、补充医学（IRR 2.41，CI 1.14 - 5.06）、医疗耗材（IRR 2.53，CI 1.69 - 3.79）和非正式护理（IRR 2.79，CI 1.56 - 5.01）方面产生的成本更高。在间接成本方面，我们发现男性在出勤主义方面的成本更高（IRR 0.6, CI 0.53 - 0.72），女性在残疾抚恤金方面的成本更高（IRR 1.62, CI 1.23 - 2.13）。
多发性硬化症给患者、家庭和社会带来了巨大的经济负担。虽然男性和女性患者的总经济负担没有差异，但我们发现在特定成本项目上存在性别差异，这与更广泛的非多发性硬化症人群中的情况相似。
