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Multiple Sclerosis The Manifold Economic Impact of Multiple Sclerosis – Indirect and Direct Costs of Managing Patients David W Brandes 1 and Peter Rieckmann 2 1. Neurologist, Hope Neurology, Knoxville, Tennessee, US; 2. Professor and Director, Department of Neurology, Bamberg Academic Hospital, University of Erlangen, Bamberg, Germany Abstract Multiple sclerosis (MS) is associated with a significant economic burden, not only in terms of direct costs (drugs, hospital admissions, healthcare aids), but also indirect costs including loss of income, reduction of productivity, burden on caregivers and family members, and a reduction in patient quality of life (QoL). The disease has a marked effect on employment, with less than 20 % of patients of working age in employment at higher disability levels (Expanded Disability Status Scale [EDSS] 6.0–8.0). Disabilities, fatigue, cognitive impairments, transportation difficulties, speech impairments and bladder and bowel problems all impact on the patient’s ability to work and their QoL. The economic costs of MS do not just impact the patient. The stress and physical burden of caring for a friend or relative with MS may also impact on the finances and health of caregivers and increase their own requirement for healthcare resources. The increasing availability of disease-modifying drugs (DMDs) and earlier diagnosis of the condition has resulted in an increase in the direct costs of MS related to expenditure on DMDs. However, due to the significant increase in costs that are associated with increasing disease severity, interventions aimed at delaying disease progression may help to reduce the economic burden of MS. This article will review the direct, indirect and intangible costs of MS and discuss the economic impact of drug development on these costs. Keywords Multiple sclerosis, disease-modifying drugs, direct costs, indirect costs, intangible costs, economic impact Disclosure: David W Brandes has been a member of the Speakers' Bureau for Acorda, Avanir, Bayer, Biogen Idec, EMD/Serono, Genzyme/Sanofi, Novartis, Questcor and Teva. He has participated on advisory boards for Avanir, Biogen Idec, Genzyme/Sanofi, Novartis, Questcor and Teva, and has received research support from Biogen Idec and Teva. Peter Rieckmann has served on scientific advisory boards for Merck Serono, Novartis, Teva and Bayer-Schering Pharma. He has also received speaker and/or consulting honoraria from Bayer-Schering Pharma, Biogen Idec, Merck Serono, Novartis and Teva. Acknowledgements: Editorial assistance was provided by Janet Manson at Touch Medical Media and was funded by Genzyme. Received: 30 November 2012 Accepted: 10 December 2012 Citation: European Neurological Review, 2012;7(Suppl. 2):17–23 Correspondence: David W Brandes, Hope Neurology, 10800 Parkside Drive, Suite 202, Knoxville, TN 37934, US. E: dwbnorth@sbcglobal.net Multiple sclerosis (MS) is the most prevalent neurological disease among young adults, affecting 30 out of 100,000 people globally; prevalence is particularly high in Europe, North America and parts of Australia, with rates over 100 per 100,000. 1 The incidence of the disease is considered to rise with increasing distance from the equator though recent data suggest this may be changing. 2 The incidence of MS is also generally increasing, especially in females and has been attributed to various factors including the increasing urbanisation of populations. 3 MS is associated with both high direct and indirect medical costs, and all costs increase with worsening disability. Patients with more severe disability (Expanded Disability Status Scale [EDSS] >7) may have annual costs four to five times higher than patients living with less disability (EDSS <4). 4 MS displays a wide range of clinical symptoms that negatively impact patients’ and caregivers’ health related quality of life (HRQoL). Regardless of disability level, relapses significantly increase the cost of the disease, mainly due to associated hospitalisations and medications. Because the onset of MS usually occurs during the years of an individual’s highest productivity and earning potential, MS has a severe and long-term effect on income and employment and ultimately quality of life (QoL). Direct medical costs of MS in the US © TOUCH MEDICAL MEDIA 2012 are estimated to total in excess of US$10 billion per year 5,6 and a recent European study showed that the total cost of MS in Europe was approximately US$18.9 billion (€14.6 billion). 7 Disease-modifying drugs (DMDs) have been available since the mid 1990s and are offered as subcutaneous injections (interferon beta-1a [IFNβ-1a], interferon beta-1b [IFNβ-1b], glatiramer acetate [GA]), intramuscular injections (IFNβ-1a), intravenous infusions of monoclonal antibodies (natalizumab) or more recently as oral agents (such as fingolimod or teriflunomide). These medications modify the natural course of the disease by decreasing relapses and the inflammatory lesion load and to some extent also slowing disability progression. However, as mainly biological preparations, they are expensive compared with older symptomatic treatments (e.g. the antispastic agent baclofen), most are intended for long term treatment and some have significant side effects requiring more intensive patient management. As a result the proportion of the cost of MS represented by drug expenses has risen significantly in the last two decades. A recent study noted that the direct cost per MS patient nearly quadrupled in Italy during the period 1996-2004 and attributed this change to the availability of DMDs and the cost of diagnostics. 8 17