Monday, 29 September 2014

How much does a Relapse Cost?

K. O׳Connell K et al. Economic costs associated with an MS relapse Mult Scler Rel DisordDOI: 10.1016/j.msard.2014.09.002

Background:Multiple sclerosis (MS) commonly affects young adults and can be associated with significant disability resulting in considerable socioeconomic burden for both patient and society.
Aims:The aim was to determine the direct and indirect cost of an MS relapse.
Methods: This was a prospective audit composed of medical chart review and patient questionnaire. Relapses were stratified into 3 groups: low, moderate and high intensity. Age, gender, MS subtype, disease duration,expanded disability status scale (EDSS) score, disease modifying therapy (DMT) use and employment status were recorded. Direct costs included GP visits, investigations, clinic visit, consultations with medical staff, medication and admission costs. Indirect costs assessed loss of earnings, partner׳s loss of earnings, childcare, meals and travel costs.
Results: Fifty-three patients had a clinically confirmed relapse. Thirteen were of low intensity; 23 moderate intensity and 17 high intensity with mean costs of €503, €1395 and €8862, respectively. Those with high intensity episodes tended to be older with higher baseline EDSS (p<0.003) and change in EDSS (p<0.002). Direct costs were consistent in both low and moderate intensity groups but varied with length of hospital stay in the high intensity group. Loss of earnings was the biggest contributor to indirect costs. A decision to change therapy as a result of the relapse was made in 23% of cases, further adding to annual MS related costs.
Conclusions: The cost of an MS relapse is dependent on severity of the episode but even low intensity episodes can have a significant financial impact for the patient in terms of loss of earnings and for society with higher annual MS related costs.
How much does a relapse cost is so difficult to calculate and in human terms this could be devastating. One catastrophic relapse where the lesions occur in a very important place, can leave you very disabled...So my advice is best not to have them.

However, there are monitory costs also...this paper does not concern itself with the costs to the affected person which could equally be devastating, such as loss of employment....So my advice is best not to have relapses

However their are costs to the hospital service too. How much are the costs...This depends on where you are located if it was Dr. House in the USA doing the work up you would have brain biopsy lumbar puncture, brain scane etc etc etc. However this study was based out of the Republic of Ireland (Eire).

The average cost in Ireland is €15,000 per year for first-line therapy rising to €22,000 per year for second-line agents and are a significant contributor to the direct costs early in the disease.
The cost of an MS relapse was determined by the severity of the episode and the baseline disability level of the person with MS.  Higher costs were driven primarily by hospital admission and length of stay.

Greater variability was seen in indirect costs across all three groups as might be expected from the diverse demographics of a relatively small patient sample. Unsurprisingly, the main component of this figure was loss of earnings. MS typically affects young adults when they are most economically productive. High rates of early retirement on medical grounds are seen in patients with MS with significant socioeconomic consequences for the individual, their family and society as a whole. 

This study showed that even low intensity episodes can have significant financial implications both for the patient, in terms of loss of income and for society, with increasing annual MS related costs due to initiation or change of treatment

5 comments:

  1. Good post, relapses lead to increasing disability, higher EDSS and loss of income, hence the high cost for the DMTs.

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    1. Sorry to burst this bubble but the high cost of DMT is because they have got away with charging these mega prices and people with MS are willing to pay these. DMF the precursor to BG-12 cost a few pence yet in USA most DMT cost about $50,000. CAMPATH-1H was about a twentieth the cost of Lemtrada. Yes the trials cost alot and cost needs to be recouped by cost is about profit and paying shareholders....lets not kid ourselves

      The cost of drug has very little to do with manufacture these days

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    2. Do people have relapses even though they are on DMTs?

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    3. Yes they can not current DMT is infalable in Alemtuzumab 50% of people need a retreat because of relapse. Obviously if you are getting breakthrough of disease, one needs to ask whether treatment needs to be escalated. This is at the heart of treating to NEDA. i.e. do not tolerate any disease activity. I will post on relapse on tysabri tomorrow as an example of relapse on DMT

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    4. Just listened to BBC radio 4 Four Thought with Professor Sunil Shaunak on Making Drugs Today.

      http://www.bbc.co.uk/programmes/b04jlry3

      Very apposite to what you say above Mouse Doctor. Shareholders, profit and greed drive big pharma.

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