Monday, 13 March 2017

#GuestPost: Gisela Kobelt on the economic costs of MS in Europe

Why is the economic impact of MS so high? #MSCostofIllness #MSPatientBurden #EconomicsofMS

The following is an invited guest post-by Gisela Kobelt who presented with me at the EMSP meeting at the European Parliament last week. Her presentation complemented mine on early treatment and really put the Wow factor into the meeting; there is nothing like data to make policy makers sit up and listen. 

Guest Post: Gisela Kobelt

Gavin, like you, I really enjoyed the experience of the European Parliament, and our discussing such important topics all together! Thank much for highlighting the presentation I gave, and for sharing one of the most important findings from this data for your readers – namely that early diagnosis and early effective treatment in MS is critical.

I really appreciate the opportunity to ‘guest blog’ today and am looking forward to hearing the thoughts and opinions of your readers.

Today, I wanted to share a bit more about some findings from our research, and I’m also attaching the presentation I used last Tuesday. I’ve spent the last 4 years on this Cost of Illness research – as I am convinced that having up-to-date real life data on health related quality of life and costs are crucial for all stakeholders.

The MS Cost of Illness Study, recently published in Multiple Sclerosis Journal, provides the most up to date information on the burden of multiple sclerosis to both society and MS patients. The study was endorsed by the European Multiple Sclerosis Platform (EMSP), jointly organized by European Health Economics and MAPI Group and financed by Biogen. Over 16,000 MS patients from across the 16 countries included in the study responded to the survey, which was disseminated and supported through local MS Societies and MS clinics. The study is anonymous and ethics approval was received in all the participating countries.

This data is used in health economic models that inform decision-making and estimate the value of interventions. The data is also relevant for policy makers and health systems - providing a present day snapshot of resource consumption of MS patients, information related to employment and new insights into MS symptoms and how they impact MS patients. Although the sample is one of convenience, we targeted at least 50-100 patients at each EDSS level in every country. There are substantial differences across the samples with respect to sample sizes by country, but more importantly to average age which directly impacts disease duration within the sample, disability, work capacity, and to a lesser extent, resource consumptions. This latter is influenced not only by the needs of the disease, but also by access and availability of services. Across the countries differences in health systems, the economy, medical and family traditions mean that any comparisons should be made cautiously.

So what did I find most critical from the results? A few things stand out for me:

First, the results confirm again that, as the disease progresses and disability increases, patient quality of life decreases and costs, in particular non-health care costs increase. It is therefore obvious that early intervention to change the course of the disease makes sense.

Second, I find the effect of MS on work capacity quite dramatic and an area where we could certainly improve support to patients. Among patients who are below the retirement age, between 30-65% depending on the country are not presently working and between 20 and 65% of these are not working due to MS. This impacts not only the patient but also to the economy in terms of production losses.

Third, I found the fact that virtually all patients complained of fatigue (95%) and 70% felt they had cognitive difficulties overwhelming. Most interestingly, these symptoms are very present very early in the disease and may explain why so many patients have to leave the workforce in early disease without physical impairment. Interesting also that fatigue is the most commonly reported symptoms among working MS patients – nearly 70%. This is a symptom that could be readily accommodated in working environments by employers.

Fundamentally, despite country differences in healthcare consumption driven partly by health systems, the detrimental impact of MS on patients is the same – as the disease progresses the effects worsen – and so is the effect on the countries’ economies in terms of production losses and the need for informal carers. These we can have a positive impact on. Getting patients diagnosed early and on treatment, can change the course of disease and keep patients at the lower end of the disability spectrum.

Kobelt et al. New insights into the burden and costs of multiple sclerosis in Europe. Mult Scler. 2017 Feb.

BACKGROUND: The current focus in multiple sclerosis (MS) is on early diagnosis and drug intervention, with a view to modifying disease progression. Consequently, healthcare costs have shifted from inpatient care and rehabilitation to outpatient care.

OBJECTIVES: This European burden of illness study provides data that can be combined with other evidence to assess whether management approaches provide value to society.

METHODS: A cross-sectional study was conducted in 16 countries. Patients reported on their disease, health-related quality of life (HRQoL) and resource consumption. Descriptive analyses were performed by disease severity. Costs are reported from a societal perspective in 2015€ PPP (adjusted for purchasing power parity).

RESULTS: The 16,808 participants had a mean age of 51.5 years, and 52% had relapsing-remitting multiple sclerosis (RRMS). Work capacity declined from 82% to 8%, and utility declined from normal population values to less than zero with advancing disease. Mean costs were 22,800€ PPP in mild, 37,100€ PPP in moderate and 57,500€ PPP in severe disease; healthcare accounted for 68%, 47% and 26%, respectively. Fatigue and cognitive difficulties were reported by 95% and 71% of participants, respectively; both had a significant independent effect on utility.

CONCLUSION: Costs and utility were highly correlated with disease severity, but resource consumption was heavily influenced by healthcare systems organisation and availability of services.

Gisela at the MS Brain Health Stand; ECTRIMS 2016
Gisela Kobelt is a health economist and although semi-retired she remains very active. She is the author of an introductory guide to economic evaluation that is now available in several languages. Until the end of 1997, Gisela was Vice-President, Corporate Health Economics, at the Pharmacia & Upjohn Corporate Management Center in Stockholm and London. Prior to her responsibilities with Pharmacia, she created and headed the Health Economics department at Sandoz in Basel (Switzerland). She holds a Master’s degree from the University of Strasbourg (France), an MBA from the Institute for Management Development (IM.D./IMEDE) in Lausanne (Switzerland), and a PhD in health economics from the Karolinska Institute in Stockholm (Sweden). She speaks six languages and lectures in five.


  1. A very interesting, but sobering, study. Politicians need to take note of the findings and make an effort to help change things.

  2. I'm so pleased that work like this is being produced by people like Gisela. I have a strong sense of there being a hell of a way to go before proactive strategies, with sufficient resource allocation, adequate timescales, employment protection etc are put in place here in the U.K. and elsewhere for PwMS. But the first steps are the evidence of the reasons for a coherent approach to MS and this study certainly, it seems to me, to provide this, most especially in respect to the rationale for early, effective treatment. Combine this with accurate figures on the numbers of us with the disease and maybe, just maybe politicians and policy-makers may start to sit up and take notice. Not necessarily of benefit to those of us currently living with the disease, but for others to come - corny but true - 'From little acorns, do great big oak trees grow' Keep up the good work please Gisela and the Bart's Team.

  3. lol... kinda like saying the sky is blue. anyone got any ideas on what to do about sky being blue? it's safe for most people, but about 0.5% of the world population suffers real bad from the sky being blue....

    it's not like the governments are going to listen to an earth shattering study about a disease that impacts the auto immune system (dear god, there are so many of those but they're all so very different there is little point in trying to draw parallels or join forces... achoo). i know i know, that's in part the failing of ms societies, not doctors....

    but anyway, my point was... at this stage, i suspect you are still trying to convince your colleagues through these studies. (hopefully by now we've agreed that pollies aren't going to be moved by those studies for there are so many of them around in respect of all sorts of common and rare diseases that the pollies can't keep count...). so if you're not going to move the pollies, you're still trying to move your colleagues...

    should i feel positive about the future medical outlook re ms?

    perhaps i sound too pessimistic and too frustrated.

    perhaps. notwithstanding that i don't have ms, if i sound too pessimistic and too frustrated, perhaps you could share my pessimism and my frustrations with your slow acting colleagues and ask them (my fave question to ask of all doctors to enable me to laugh at their answers) - 'so doc, tell me, what would you do in my shoes'.

    ps. have you seen my shoes?


Please note that all comments are moderated and any personal or marketing-related submissions will not be shown.