Real World Value & Evidence, Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA.
Cerner Enviza, 51 Valley Stream Pkwy, Malvern, PA 19355, USA.
Mult Scler Relat Disord. 2022 Sep;65:103971. doi: 10.1016/j.msard.2022.103971. Epub 2022 Jun 14.
Fatigue, a common disabling symptom in multiple sclerosis (MS), is reported by the majority of patients. However, evidence on the economic burden of fatigue in MS by fatigue status is limited. This study aimed to evaluate the economic burden of fatigue, including healthcare resource utilization (HCRU), labor force participation, and Work Productivity and Activity Impairment (WPAI), among adults with relapsing-remitting MS (RRMS) by low fatigue (LF) vs high fatigue (HF) and compared with adults without MS.
This cross-sectional, retrospective, observational study included pooled data from the 2017 and 2019 US National Health and Wellness Survey. The RRMS sample included respondents aged ≥18 years who reported being diagnosed with MS by a healthcare provider (HCP) and reported having RRMS. Non-MS controls included respondents aged ≥18 years who did not report being diagnosed with MS by an HCP. Fatigue was measured using the Modified Fatigue Impact Scale-5 (MFIS-5). Outcomes included HCRU (HCP visits, emergency department visits, and hospitalizations in the past 12 months), labor force participation (yes vs no), WPAI (absenteeism, presenteeism, total work productivity impairment, and activity impairment), and annualized costs (direct medical, indirect, and total). Respondents with RRMS were propensity-score matched to non-MS controls (ratio 1:3). RRMS respondents were categorized as having LF (MFIS-5<15; RRMS+LF) and HF (MFIS-5≥15; RRMS+HF). Bivariate analysis compared matched non-MS controls, RRMS+LF, and RRMS+HF. Multivariable analyses were conducted among RRMS to evaluate associations between fatigue (continuous variable) and outcomes.
Overall, 498 respondents with RRMS (RRMS+LF, n=375; RRMS+HF, n=123) and 1494 matched non-MS controls were included. RRMS+HF and RRMS+LF had more HCRU in the past 12 months than non-MS controls, whereas RRMS+HF had greater HCRU than RRMS+LF (all p<0.05). WPAI was also higher among RRMS+HF and RRMS+LF, compared with non-MS controls, as well as higher in RRMS+HF vs RRMS+LF (all p<0.001). RRMS+HF had significantly higher annualized direct medical costs than RRMS+LF and matched non-MS controls ($19,978 vs $10,656, p=0.007; vs $8,048, p<0.001). Among employed respondents, RRMS+HF and RRMS+LF had higher annualized indirect costs than non-MS controls, with RRMS+HF also having higher annualized indirect costs than RRMS+LF ($23,647 vs $13,738 vs $8,001; all p<0.01); total annualized costs were higher in RRMS+HF and RRMS+LF, compared with non-MS controls, as well as RRMS+HF vs RRMS+LF (all p<0.01). In multivariable models, fatigue was significantly and positively associated with the number of HCP visits in the past 12 months (p=0.002); not participating in the labor force (p<0.001); and absenteeism, presenteeism, total work productivity impairment, and activity impairment (all p<0.001).
RRMS poses a substantial economic burden on patients and society, and this burden is disproportionately associated with HF.
疲劳是多发性硬化症（MS）的一种常见致残症状，大多数患者都有这种症状。然而，关于疲劳状态下 MS 疲劳的经济负担的证据有限。本研究旨在评估成年人复发缓解型 MS（RRMS）中疲劳的经济负担，包括疲劳状态下的医疗资源利用（HCRU）、劳动力参与率以及工作生产力和活动障碍（WPAI），分为低疲劳（LF）与高疲劳（HF），并与无 MS 的成年人进行比较。
这是一项横断面、回顾性、观察性研究，包括来自 2017 年和 2019 年美国国家健康和健康调查的汇总数据。RRMS 样本包括年龄≥18 岁、报告由医疗保健提供者（HCP）诊断为 MS 并报告有 RRMS 的受访者。非 MS 对照组包括年龄≥18 岁、报告未由 HCP 诊断为 MS 的受访者。疲劳使用改良疲劳影响量表-5（MFIS-5）进行测量。结果包括 HCRU（过去 12 个月的 HCP 就诊、急诊就诊和住院）、劳动力参与率（是/否）、WPAI（旷工、在职病假、总工作生产力障碍和活动障碍）以及年化成本（直接医疗、间接和总）。RRMS 受访者与非 MS 对照组进行倾向评分匹配（比例为 1:3）。RRMS 受访者分为 LF（MFIS-5<15；RRMS+LF）和 HF（MFIS-5≥15；RRMS+HF）。采用双变量分析比较匹配的非 MS 对照组、RRMS+LF 和 RRMS+HF。对 RRMS 进行多变量分析，以评估疲劳（连续变量）与结果之间的关系。
共有 498 名 RRMS 受访者（RRMS+LF，n=375；RRMS+HF，n=123）和 1494 名匹配的非 MS 对照组被纳入研究。RRMS+HF 和 RRMS+LF 在过去 12 个月的 HCRU 多于非 MS 对照组，而 RRMS+HF 的 HCRU 多于 RRMS+LF（均 P<0.05）。RRMS+HF 和 RRMS+LF 的 WPAI 也高于非 MS 对照组，以及 RRMS+HF 高于 RRMS+LF（均 P<0.001）。RRMS+HF 的年化直接医疗费用明显高于 RRMS+LF 和匹配的非 MS 对照组（$19,978 比 $10,656，P=0.007；比 $8,048，P<0.001）。在就业受访者中，RRMS+HF 和 RRMS+LF 的年化间接成本高于非 MS 对照组，RRMS+HF 的年化间接成本也高于 RRMS+LF（$23,647 比 $13,738 比 $8,001；均 P<0.01）；RRMS+HF 和 RRMS+LF 的年化总费用高于非 MS 对照组，以及 RRMS+HF 高于 RRMS+LF（均 P<0.01）。在多变量模型中，疲劳与过去 12 个月的 HCP 就诊次数显著正相关（P=0.002）；不参与劳动力（P<0.001）；以及旷工、在职病假、总工作生产力障碍和活动障碍（均 P<0.001）。
RRMS 给患者和社会带来了巨大的经济负担，而且这种负担与 HF 不成比例。
