Blinkenberg M, Kjellberg J, Ibsen R, Magyari M
Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark.
The Danish Center for Social Science Research, Copenhagen, Denmark.
Mult Scler Relat Disord. 2020 Nov;46:102567. doi: 10.1016/j.msard.2020.102567. Epub 2020 Oct 10.
Primary progressive multiple sclerosis (PPMS) is characterized by development of more chronic neurological manifestations from disease onset compared with relapsing remitting MS (RRMS) and secondary progressive MS (SPMS) but the following socioeconomic consequences have never been described in a nation-wide patient population.
To determine if socioeconomic burden of PPMS is increased compared with RRMS and SPMS.
We included patients from The Danish Multiple Sclerosis Registry diagnosed between 1998 and 2015. Yearly average health costs, public transfers and earned income was calculated from the index diagnosis date, and each year in a five-year period before and after index diagnosis date, for the three patient groups. A regression model estimating the odds ratio (OR) with PPMS as the comparator, was used to analyze the differences between PPMS vs. RRMS and PPMS vs. SPMS controlling for age and sex.
In total, 9563 MS patients were identified (1998-2015), with a characteristic distribution between different disease courses: 7012 patients with RRMS (73%), 1099 patients with PPMS (11%) and 1452 patients with SPMS (15%). Total health costs were lower in RRMS vs. PPMS (OR 0.76; 95% CI 0.74-0.78; p<0.0001) but not in SPMS vs. PPMS (OR 1.06; 95% CI 1.03-1.09; p<0.0001). Especially homecare costs were lower in RRMS vs. PPMS (OR 0.17; 95% CI 0.17-0.18; p<0.0001), less pronounced in SPMS vs. PPMS (OR 0.93; 95% CI 0.90-0.97; p = 0.0001). OR for health costs before and after diagnosis was significantly lower in RRMS vs. PPMS regarding most variables, less pronounced in SPMS vs. PPMS.
This nation-wide population-based study show that socioeconomic burden is significantly higher in PPMS relative to RRMS, but less pronounced compared with SPMS.
与复发缓解型多发性硬化症（RRMS）和继发进展型多发性硬化症（SPMS）相比，原发性进展型多发性硬化症（PPMS）的特点是自疾病发作起就出现更为慢性的神经学表现，但在全国范围的患者群体中，尚未描述过其后续的社会经济后果。
确定与RRMS和SPMS相比，PPMS的社会经济负担是否增加。
我们纳入了丹麦多发性硬化症登记处1998年至2015年间诊断的患者。计算了三组患者从索引诊断日期起以及索引诊断日期前后五年内每年的平均医疗费用、公共转移支付和劳动收入。使用以PPMS作为对照的回归模型估计比值比（OR），以分析PPMS与RRMS以及PPMS与SPMS之间在控制年龄和性别后的差异。
总共确定了9563例多发性硬化症患者（1998 - 2015年），不同病程之间具有特征性分布：7012例RRMS患者（73%），1099例PPMS患者（11%），1452例SPMS患者（15%）。RRMS的总医疗费用低于PPMS（OR 0.76；95% CI 0.74 - 0.78；p<0.0001），但SPMS与PPMS相比无差异（OR 1.06；95% CI 1.03 - 1.09；p<0.0001）。尤其是RRMS的家庭护理费用低于PPMS（OR 0.17；95% CI 0.17 - 0.18；p<0.0001），在SPMS与PPMS相比时差异不那么明显（OR 0.93；95% CI 0.90 - 0.97；p = 0.0001）。在大多数变量方面，RRMS诊断前后的医疗费用OR显著低于PPMS，在SPMS与PPMS相比时差异不那么明显。
这项基于全国人口的研究表明，PPMS的社会经济负担相对于RRMS显著更高，但与SPMS相比差异不那么明显。
