Jürgen Wasem, Yanic Heer, Eleni Karamasioti, Erwan Muros-Le Rouzic, Giuseppe Marcelli, Danilo Di Maio, Stefan Braune, Gisela Kobelt, Paul Dillon
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Cost analyses included indirect/direct medical and non-medical costs. Eight subgroups, ranging from 439 to 1812 patients were created based on presence of measures for disease progression (EDSS), cognition (Symbol Digit Modalities Test [SDMT]), fatigue (Modified Fatigue Impact 5-Item Scale [MFIS-5]), ULF (Nine-Hole Peg Test [9HPT]), and LLF (Timed 25-Foot Walk [T25FW]). Multivariable linear regression assessed the independent effect of each test's score on QoL and costs, while adjusting for EDSS and 12 other confounders.</p><p><strong>Results: </strong>Lower QoL was associated with decreasing cognition (p < 0.001), worsening ULF (p = 0.025), and increasing fatigue (p < 0.0001); however, the negative impact of LLF worsening on QoL was not statistically significant (p = 0.54). Higher costs were associated with decreasing cognition (p < 0.001), worsening of ULF (p = 0.0058) and LLF (p = 0.049), and increasing fatigue (p < 0.0001). Each 1-scale-step worsening function of SDMT, MFIS-5, 9HPT, and T25FW scores resulted in €170, €790, €330, and €520 higher costs, respectively. Modeling disability progression based on SDMT, MFIS-5, 9HPT, and T25FW scores as an interaction with EDSS strata found associations with lower QoL and higher costs at variable EDSS ranges.</p><p><strong>Conclusions: </strong>Disease progression in MS measured by 9HPT, SDMT, and MFIS-5 had a significant negative impact on QoL and broad socioeconomic costs independent of EDSS. T25FW had a significant negative association with costs. Cognition, fatigue, ULF, and LLF have stronger impact on costs and QoL in patients with higher EDSS scores. Additional determinants of MS disability status, including SDMT, MFIS-5, 9HPT, and T25FW, should be considered for assessing cost effectiveness of novel therapeutics for MS.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":"665-678"},"PeriodicalIF":2.0000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362420/pdf/","citationCount":"0","resultStr":"{\"title\":\"Cost and Quality of Life of Disability Progression in Multiple Sclerosis Beyond EDSS: Impact of Cognition, Fatigue, and Limb Impairment.\",\"authors\":\"Jürgen Wasem, Yanic Heer, Eleni Karamasioti, Erwan Muros-Le Rouzic, Giuseppe Marcelli, Danilo Di Maio, Stefan Braune, Gisela Kobelt, Paul Dillon\",\"doi\":\"10.1007/s41669-024-00501-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objective: </strong>Understanding the socioeconomic burden of multiple sclerosis (MS) is essential to inform policymakers and payers. 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引用次数: 0
摘要
背景和目的:了解多发性硬化症(MS)的社会经济负担对于为政策制定者和支付者提供信息至关重要。现实世界的研究表明,随着残疾程度的加深,成本也在增加,生活质量(QoL)也在恶化。本研究旨在进一步评估认知、疲劳、上肢和下肢功能(ULF、LLF)损伤以及每级扩展残疾状况量表(EDSS)的疾病进展对成本和 QoL 的影响:这是一项横断面队列研究,包括 2009 年至 2019 年德国 NeuroTransData MS 登记处的 20988 名患者。QoL 分析基于 EQ-5D-5L。成本分析包括间接/直接医疗和非医疗成本。根据疾病进展(EDSS)、认知(符号数字模型测试 [SDMT])、疲劳(改良疲劳影响 5 项量表 [MFIS-5])、超低强度(九孔钉测试 [9HPT])和低强度(25 英尺定时步行 [T25FW])等指标的存在情况,创建了 8 个亚组,患者人数从 439 人到 1812 人不等。多变量线性回归评估了每种测试得分对 QoL 和费用的独立影响,同时调整了 EDSS 和其他 12 种混杂因素:结果:质量生活水平的降低与认知能力的下降有关(P<0.05):通过 9HPT、SDMT 和 MFIS-5 测定的多发性硬化症疾病进展对 QoL 和广泛的社会经济成本有显著的负面影响,与 EDSS 无关。T25FW 与费用有明显的负相关。对于 EDSS 评分较高的患者,认知、疲劳、ULF 和 LLF 对费用和 QoL 的影响更大。在评估 MS 新型疗法的成本效益时,应考虑 MS 残疾状况的其他决定因素,包括 SDMT、MFIS-5、9HPT 和 T25FW。
Cost and Quality of Life of Disability Progression in Multiple Sclerosis Beyond EDSS: Impact of Cognition, Fatigue, and Limb Impairment.
Background and objective: Understanding the socioeconomic burden of multiple sclerosis (MS) is essential to inform policymakers and payers. Real-world studies have associated increasing costs and worsening quality of life (QoL) with disability progression. This study aims to further evaluate the impact of cognition, fatigue, upper and lower limb function (ULF, LLF) impairments, and disease progression per Expanded Disability Status Scale (EDSS) level, on costs and QoL.
Methods: This was a cross-sectional cohort study including 20,988 patients from the German NeuroTransData MS registry from 2009 to 2019. QoL analyses were based on EQ-5D-5L. Cost analyses included indirect/direct medical and non-medical costs. Eight subgroups, ranging from 439 to 1812 patients were created based on presence of measures for disease progression (EDSS), cognition (Symbol Digit Modalities Test [SDMT]), fatigue (Modified Fatigue Impact 5-Item Scale [MFIS-5]), ULF (Nine-Hole Peg Test [9HPT]), and LLF (Timed 25-Foot Walk [T25FW]). Multivariable linear regression assessed the independent effect of each test's score on QoL and costs, while adjusting for EDSS and 12 other confounders.
Results: Lower QoL was associated with decreasing cognition (p < 0.001), worsening ULF (p = 0.025), and increasing fatigue (p < 0.0001); however, the negative impact of LLF worsening on QoL was not statistically significant (p = 0.54). Higher costs were associated with decreasing cognition (p < 0.001), worsening of ULF (p = 0.0058) and LLF (p = 0.049), and increasing fatigue (p < 0.0001). Each 1-scale-step worsening function of SDMT, MFIS-5, 9HPT, and T25FW scores resulted in €170, €790, €330, and €520 higher costs, respectively. Modeling disability progression based on SDMT, MFIS-5, 9HPT, and T25FW scores as an interaction with EDSS strata found associations with lower QoL and higher costs at variable EDSS ranges.
Conclusions: Disease progression in MS measured by 9HPT, SDMT, and MFIS-5 had a significant negative impact on QoL and broad socioeconomic costs independent of EDSS. T25FW had a significant negative association with costs. Cognition, fatigue, ULF, and LLF have stronger impact on costs and QoL in patients with higher EDSS scores. Additional determinants of MS disability status, including SDMT, MFIS-5, 9HPT, and T25FW, should be considered for assessing cost effectiveness of novel therapeutics for MS.
期刊介绍:
PharmacoEconomics - Open focuses on applied research on the economic implications and health outcomes associated with drugs, devices and other healthcare interventions. The journal includes, but is not limited to, the following research areas:Economic analysis of healthcare interventionsHealth outcomes researchCost-of-illness studiesQuality-of-life studiesAdditional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in PharmacoEconomics -Open may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.All manuscripts are subject to peer review by international experts. Letters to the Editor are welcomed and will be considered for publication.