Costs and quality of life of multiple sclerosis in Italy

This cost-of-illness analysis based on information from 921 patients in Italy is part of a Europe-wide cost-of-illness study in multiple sclerosis (MS). The objective was to analyze the costs and quality of life (QOL) related to the level of disease severity and progression. Patients registered with the Italian MS patient organization were asked to participate in a mail survey, and 31% responded. The questionnaire asked for details on the disease (type of disease, relapses, level of functional disability), information on all medical and non-medical resource consumption, and informal care and work capacity (sick leave and early retirement). In addition, patients were asked about their current QOL (in the form of utility) and the level of fatigue. The mean age of respondents was 46 years, and 8.5% were 65 years or older. As many as 20% of patients had severe disease (Expanded Disability Status Scale [EDSS] score of ≥7), 47% had moderate disease (EDSS score of 4–6.5) and only 31% had mild disease (EDSS score of 0–3). Thus, the mean EDSS score in the sample was 4.6 (median 5.0), with a utility of 0.53 (range: 0 = death to 1 = full health) and a fatigue level of 6.4 (range: 1 = not tired to 10 = extremely tired). Costs and utility are highly correlated with disease severity. Workforce participation decreases from approximately 80% in early disease to less than 10% in the very late stages. Total costs increase fivefold between an EDSS score of 0–1 and a score of 7. Health-care costs, however, show a limited increase with worsening disease – hospitalization increases from € 800 per patient to € 3200, and ambulatory care increases from € 900 to € 1500. Productivity losses, on the other hand, increase by a factor of 12, while informal care increases from € 500 at an EDSS score of 0–1 to nearly € 25 000 at an EDSS score of 7, and € 39 000 at an EDSS score of 8–9. Hence, total mean costs per patient are determined essentially by the distribution of the severity levels in the sample, increasing from € 12 000 at an EDSS score of 0–1 to € 57 000 at an EDSS score of 7, and € 71 000 at an EDSS score of 8–9. The same is true for utility, which decreases from 0.80 to 0.06 as the disease becomes severe. However, the utility loss compared to the age- and gender-matched general population is high at all levels of the disease, leading to an estimated annual loss of 0.3 quality-adjusted life year (QALY) per patient. Relapses for patients with an EDSS score of <5 are associated with a cost of approximately € 4000 and a utility loss of 0.18 during the quarter in which they occur.     

Costs and quality of life of multiple sclerosis in the United Kingdom

This cost-of-illness analysis for the United Kingdom is part of a Europe-wide study on the costs of multiple sclerosis (MS). The objective was to analyze the costs and quality of life (utility) related to the level of disease severity. People with MS from a database administered by a UK charity (the MS Trust) were asked to participate in the survey by answering a postal questionnaire. In addition to details on the disease (type of disease, relapses, level of functional disability), the questionnaire asked for information on all resource consumption, medical, non-medical, work absence and informal care as well as utility. The response rate was 19%, and a total of 2048 people were included. The mean age of the cohort was 51 years, and 23% of people were ≥60 years of age. Disease severity was concentrated in people with moderately severe MS (Expanded Disability Status Scale [EDSS] score of 4 to 6.5), with 21, 60 and 19% of people reporting mild, moderate and severe disease, respectively. Costs and utility are highly correlated with disease severity. Mean annual costs for all people in the study increase from approximately £ 12.000 at an EDSS score <4 to almost £ 60.000 at an EDSS score ≥7. In particular, employment rates are reduced from 82% in early disease to 2% at an EDSS score of 8, while the costs of inpatient care, investments, informal care and productivity losses increase by more than tenfold between an EDSS score of 0-1 and a score ≥7. Utility decreases from 0.92 at an EDSS score of 0 to a state worse than death in the most severe state (–0.18 at an EDSS score of 9). Compared to the results in an earlier cost study in the United Kingdom using a comparable methodology, costs have substantially increased, by roughly 40%. Part of the increase is due to a higher use of disease-modifying drugs and, possibly linked with this, a higher use of ambulatory care and services. Another part of the increase is most likely due to an increased age in the current sample, with more patients on early retirement due to MS and more intense use of informal care. However, another reason may lie in the methodology, e.g. different unit costs or differences in the sample distribution, despite a similar mean EDSS score of 5.1.     

Costs and quality of life of multiple sclerosis in Austria

This cost-of-illness analysis is part of a Europe-wide study on the costs of multiple sclerosis (MS) and is based on information from patients in Austria. The objective was to estimate the costs and quality of life (QOL) related to the level of disease severity and progression. Questionnaires were sent to 2995 patients registered with a nationwide patient organization. Patients were asked to provide details regarding the type of disease, relapses, level of functional disability, resource consumption (medical and non-medical), work absence, sick leave and informal care, as well as QOL. Surveys from a total of 1.019 (34.0%) patients were used in the analysis, of which the mean (standard deviation [SD]) age was 50 (12.2) years; 70% of patients were female. Patients with mild disease (Expanded Disability Status Scale [EDSS] score 0–3) represented 41% of patients, 36% had moderate disease (EDSS score 4–6.5) and 22% had severe disease (EDSS score ≥7). The mean (SD) EDSS score in the sample was 4.4 (2.4), with a mean (SD) utility of 0.55 (0.32).Costs are presented from the societal perspective as well as from the viewpoint of payers of care and invalidity. Mean total annual costs for an average patient in the sample were estimated at € 40.300 in the societal perspective, whereas payers’ costs were estimated at only half of this. Disease-modifying drugs represented a quarter of all costs in the payer perspective, but only 12% of societal costs. For society, the highest cost was the loss of productivity (36%), while payments for this loss (invalidity pensions and sick-leave compensation) accounted for only 21% of total costs to payers. Costs are highly correlated with disease progression, increasing four-fold from early disease to very severe disease (€ 16.000 to € 63.800). Mean annual costs per patient reported are thus determined by the distribution of disease severity in the sample. Workforce participation decreases from roughly 75% in early disease to less than 10% in the late stages, despite the fact that 70% of patients with an EDSS score of 8 or 9 are still below the official retirement age. Consequently, productivity losses increase over fivefold. In parallel, costs of informal care increase from € 325 per year at an EDSS score of 0–1 to over € 20.000 at an EDSS score of 8–9. Hospitalization is very infrequent in early disease, representing less than € 1.000 for patients with an EDSS score of 0–1, but increases steeply for patients with an EDSS score ≥5. QOL, measured as utility scores, decreases rapidly from almost 0.90 to 0.05 as disability becomes severe. However, the loss of utility is evident at all disease levels. Young patients with an EDSS score of approximately 2 have a utility that is 0.15 lower than matched individuals from the general population. This loss increases to approximately 0.4 for patients over 60 years of age with an average EDSS score of 6.0–6.5. Patients with a recent relapse had lower utility (–0.1) and higher costs (+ € 4.750).     

Costs and quality of life for patients with multiple sclerosis in Belgium

This cost-of-illness analysis for Belgium is part of a Europe-wide study on the costs of multiple sclerosis (MS). The objective was to analyze the costs and quality of life (QOL) related to the level of disease severity. Patients from four specialized MS centres participated in the survey by answering a mail questionnaire. In addition to details on the disease (type of disease, relapses, level of functional disability), the questionnaire asked for information on all medical and non-medical resource consumption, sick leave, early retirement, informal care as well as QOL (in the form of utility weights). A total of 799 respondents were included in the analysis (response rate 38%). The mean age of the cohort was 48 years, and 12% of patients were 65 years or older. Forty-six percent of patients had mild disease (Expanded Disability Status Scale [EDSS] score 0–3), 20% severe disease (EDSS score ≥7), and the mean EDSS score in the sample was 4.2 (median 4.0), with a utility of 0.51. Costs and utility are highly correlated with disease severity. Workforce participation decreases from approximately 75 to 80% in early disease to approximately 6% in the very late stages. Hospitalization and ambulatory visits increase by a factor of 10 between early and late disease; investments and services increase from basically no cost to € 6.000 to € 7.000 per year; productivity losses increase ninefold; and informal care increases from € 300 per year at an EDSS score of 0–1 to € 15.000 to € 16.000 per year at an EDSS score ≥7. Hence, total mean costs per patient are driven essentially by the distribution of the severity levels in the sample, increasing from approximately € 12.000 per year at an EDSS score of 0–1 to € 51.500 per year at an EDSS score of 8-9. The same is true for utility, which decreases from 0.85 to 0.06 as the disease becomes severe. However, the utility loss compared to the general population is high at all levels of the disease (0.25 at an EDSS score of 2 to 0.44 at an EDSS score 5–6 leading to an estimated loss of 0.3 quality-adjusted life-year (QALY) per patient. Relapses for patients with an EDSS score <5 are associated with a cost of approximately € 3.360 and a utility loss of 0.1 during the quarter in which they occur. Public payers (health-care costs, community care, sick payments and invalidity pensions) cover an estimated 55% of all costs.     

Costs and quality of life of multiple sclerosis in Germany

This cost-of-illness analysis based on information from 2973 patients with multiple sclerosis (MS) in Germany is part of a Europe-wide study on the costs of MS. The objective was to analyze the costs and quality of life (QOL) related to the level of disease severity. Patients from six centres (office- and hospital-based physicians) and patients enrolled in a database were asked to participate in the survey; 38% answered a mail questionnaire. In addition to details on the disease (type of disease, relapses, level of functional disability), the questionnaire asked for information on all resource consumption, medical, non-medical, work absence, informal care, as well as QOL (measured as utility). The mean age of the cohort was 45 years, and 18% of patients were 65 years of age or older. Forty-seven percent of patients had mild disease (Expanded Disability Status Scale [EDSS] score 0–3), 36% had moderate disease (EDSS score 4–6.5) and 12% had severe disease (EDSS score ≥7). The mean EDSS score in the sample was 3.8 (median 4.0), with a mean utility of 0.62. Costs and utility are highly correlated with disease severity. Workforce participation decreases from 73% in very early disease to less than 10% in the very late stages, leading to a tenfold rise in productivity losses in the late stages of disease. Hospitalisation and ambulatory visits rise by a factor of 5–6 between early and late disease; investments and services increase from basically no cost to € 2700; and informal care increases by a factor of 27 for patients with an EDSS score of 7 and by a factor of 50 for patients at the very severe end of the EDSS scale (8–9). Hence, total mean costs per patient are determined essentially by the distribution of the severity levels in the sample, increasing from approximately € 18 500 at an EDSS score of 0–1 to € 70 500 at an EDSS score of 8–9. The same is true for utility, which decreases from 0.86 to 0.10 as the disease becomes severe. However, the utility loss compared to the general population is high at all levels of the disease, leading to an estimated loss of 0.2 quality-adjusted life-years per patient. Relapses are associated with a cost of approximately € 3 000 and a utility loss of 0.1 during the quarter in which they occur. Compared with a similar study performed in 1999, resource consumption, with the exception of drugs, is somewhat lower. This is most likely due to a difference in the severity distribution of the two samples and to changes in health-care consumption overall in the country, such as the introduction of diagnosis-related groups (DRGs, Fallpauschalen).     

Costs and quality of life in multiple sclerosis in The Netherlands

This cost-of-illness analysis based on information from 1.549 patients in The Netherlands is part of a Europe-wide study on the costs of multiple sclerosis (MS). The objective was to analyze the costs and quality of life (QOL) related to the level of disease severity and progression. Patients from three specialized MS centres participated in the survey by answering a mail questionnaire (response rate, 52%). In addition to details on the disease (type of disease, relapses, level of functional disability), the questionnaire asked for information on all resource consumption, medical, non-medical, work absence, early retirement and informal care as well as QOL (expressed as utility). The mean age of the cohort was 47 years, and 7.6% of patients were 65 years of age or more. Forty-eight percent of patients had mild disease [Expanded Disability Status Scale (EDSS) score of 0–3], 40% moderate disease (EDSS score of 4–6.5) and 11% severe disease (EDSS score of 7 and above). The mean EDSS score in the sample was 3.9 (median 4.0), with a utility of 0.61. Costs and utility are highly correlated with disease severity. Workforce participation decreases from around 75 to 80% in early disease to less than 5% in the very late stages. Hospitalization is very infrequent in early disease, representing less than € 500 per year for patients at EDSS scores below 6, but increases steeply for patients at an EDSS score of 7 and above. Ambulatory care increases fivefold between early and late disease, while services rise from basically no cost to almost € 8.000 per year at an EDSS score of 7 and € 19.000 per year at EDSS scores of 8–9. Productivity losses are multiplied by 10 in late disease, while informal care increases from € 300 per year at EDSS scores of 0–1 to nearly € 15.000 per year at EDSS scores of 8–9. Hence, total mean costs per patient are driven essentially by the distribution of the severity levels in the sample, increasing from € 9.300 per year at EDSS scores of 0–1 to € 50.000 per year at an EDSS score of 7 and € 78.000 per year at EDSS scores of 8–9. The same is true for utility, which decreases from 0.85 to 0.05 as the disease becomes severe. However, the utility loss compared to the age- and gender-matched general population is high at all levels of the disease (0.25 at an EDSS score of 2 to 0.4 at EDSS scores of 5–6), leading to an estimated annual loss of 0.24 quality-adjusted life-years (QALYs) per patient. Relapses for patients with an EDSS score below 5 are associated with a cost of around € 2.800 and a utility loss of 0.15 during the quarter in which they occur.     

Costs and quality of life of multiple sclerosis in Spain

This cost-of-illness analysis is based on information from 1.848 patients in Spain and is part of a Europe-wide study on the costs of multiple sclerosis. The objective was to analyze the costs and quality of life (QOL) related to the level of disease severity and progression. Patients were identified by the Asociación Española de Esclerosis Múltiple (AEDEM) and participated in the survey by answering a mail questionnaire (response rate 31.8%). In addition to details on the disease (type of disease, relapses, level of functional disability), the questionnaire asked for information on all resource consumption, medical, non-medical, work absence and informal care, as well as utility (QOL). The mean age of the cohort was 45 years, and only 5.5% of patients were 65 years of age or more. Approximately 36% of patients had mild disease (Expanded Disability Status Scale [EDSS] score of 0–3), 44.8% had moderate disease (EDSS score of 4–6.5) and 17.7% had severe disease (EDSS score ≥7). The mean EDSS score in the sample was 4.5 (median 5.0), with a utility of 0.554. Costs and utility are highly correlated with disease severity. Workforce participation decreases from around 70% in early disease to less than 5% in the very late stages. Hospitalization is very infrequent in early disease, representing less than € 1.300 per patient per year for patients at EDSS scores <6, but increases steeply for patients at scores ≥7. Ambulatory care increases fivefold between early and late disease, while investments and services increase from basically no cost to just over € 6.000 at EDSS scores ≥7. Productivity losses increase more than eightfold, and informal care increases from € 593 at EDSS scores of 0–1 to nearly € 34.228 at scores of 8–9. Hence, total mean costs per patient are driven by the distribution of the severity levels in the sample, increasing from € 10.425 at EDSS scores of 0–1 to € 45.264 at a score of 7, and € 65.693 at scores of 8–9. The same is true for utility, which decreases from 0.865 to 0.084 as patients progress from the mildest to the most severe disability levels. However, the utility loss compared to the age- and gender-matched general population is high at all levels of the disease (～0.25 in patients below 30 years of age with an EDSS score of 2–3, and ～0.4 in patients over 60 years of age and a score of ≥6), leading to an estimated annual loss of 0.276 quality-adjusted life-year per patient. Relapses for patients with an EDSS score below 5 are associated with a cost of approximately € 2.750 and a utility loss of 0.1 during the quarter in which they occur.     

Costs and quality of life of multiple sclerosis in Sweden

The study objective was to analyse the costs and quality of life (QOL) of multiple sclerosis (MS) related to disease severity in Sweden as part of a study in nine European countries. Information on demographics, disease, resource utilisation, informal care needs, work capacity and QOL (utility) was collected using a questionnaire that was sent to patients registered with the Swedish organisation of patients with neurological disabilities (Neurologiskt Handikappades Riksförbund). The study used a prevalence-based and cross-sectional approach, and costs were estimated from a societal perspective. A total of 1,339 patients were included in the analysis. Seventy-three percent of patients were female, and the mean age was 53 years (standard deviation [SD], 12 years). The mean Expanded Disability Status Scale (EDSS) score was 5.1 (SD, 2.2); only 29% of patients had mild disease (EDSS score <4), 46% had moderate disease and 25% had severe disease (EDSS score ≥7). Costs were significantly correlated with disease severity, increasing sevenfold from around € 16.000 at EDSS scores of 0–1 to € 116.000 at EDSS scores of 8–9. At the same time, utility decreased with worsening disease from 0.825 to 0.047, with a mean established at 0.546 (SD, 0.287). This is significantly lower than utilities for an age- and gender-matched sample of the general population, which would be estimated at 0.80–0.85. Patients with a relapse during the last 3 months had a significant cost increase, of € 3.080, and a utility loss of 0.088. Costs and utilities are highly correlated with EDSS score, and the mean cost per patient in the sample is thus heavily influenced by the severity distribution in the sample. Compared to European estimates, patients with moderate and severe disease in our sample appear to be overrepresented, and costs can therefore not be directly extrapolated to the overall MS population in Sweden without adjustment. When correcting for estimated actual prevalence and use of disease modifying drugs (DMDs), the total cost of MS in Sweden is estimated at € 600 million. Compared to an earlier cost study in 1998 that included a similar sample, and adjusting for differential timing and estimated national use of DMDs, costs have increased by approximately 5% between 1998 and 2005.     

Costs and quality of life in multiple sclerosis

We performed a cross-sectional, “bottom-up” observational study of resource use, costs, and quality of life in patients with multiple sclerosis (MS) in Germany. Six centers participated in the study. Patients were asked to complete a questionnaire, and a total of 737 patients returned it (response rate 66%). The questionnaire provided information on all resource consumption, medical, and nonmedical, work absence, informal care related to their MS, and quality of life (EuroQol). Simultaneously, medical charts were also abstracted for a subsample of 202 patients for comparison between answers in the questionnaires and registered data. Levels of disability were assessed using the Expanded Disability Status Scale. The mean age of the cohort was 41.9±14.1 years (disease onset 33.4), mean EDSS score 4.4 (range 1.0–9.5), and mean utility measured by EQ-5D 0.552±0.331). Mean total cost per patient and year was 65,400 DM, adjusted for use of interferons, which was higher in this sample than the current average use in Germany. When this cost is extrapolated to an estimated patient population of 120,000, total costs to society are estimated at 7.85 billion DM. Direct costs represented 57.5%, informal care accounted for 12.1% and indirect costs amounted to 42.5%. Public payers pay for an estimated 24,800 DM per patient or 38% of total costs. All types of costs (direct, informal care, indirect) increased with increasing disability, while utilities decreased.     

Costs of dementia in Hungary

Objective

The main aim of this paper is to give an overview on the quality of life, health care utilisation and costs of dementia in Hungary.

Method

A cross-sectional non-population based study of 88 consecutive dementia patients and their caregivers was conducted in three GP practices and one outpatient setting in 2008. Resource Utilization in Dementia (RUD), Mini Mental State Examination (MMSE) and quality of life (EQ-5D) were surveyed and cost calculations were performed. Costs of patients living at home were estimated by the current bottom-up cost-of-illness calculations, while costs of nursing home patients were considered by official reimbursement to determine the disease burden from a societal viewpoint.

Results

The mean age of the patients was 77.4 years (SD=9.2), 59% of them were female. The mean MMSE score was 16.70 (SD=7.24), and the mean EQ-5D score was 0.40 (SD=0.34). The average annual cost of dementia was 6,432 Euros per patient living at home and 6,086 Euros per patient living in nursing homes. For the whole demented population (based on EuroCoDe data) we estimated total annual costs of 846.8 million Euros; of which 55% are direct costs, 9% indirect costs and 36% informal care cost. Compared to acute myocardial infarction the total disease burden of dementia is 26.3 times greater.

Conclusions

This is the first study investigating resource utilisation, costs, and quality of life of dementia patients in the Central and Eastern European region. Compared to the general population of Hungary EQ-5D values of the demented patients are lower in all age groups. Dementia related costs are much lower in Hungary compared to Western European countries. There is no remarkable difference between the costs of demented patients living at home and in nursing homes, from the societal point of view.     

Economic aspects of smoking

Smoking has become a major issue for public health policy in recent years. This paper deals with the economic aspects of smoking. First, we outline the basic concepts of welfare economics which subsequently are used as the normative framework of the analysis. In particular, we stress the role of efficiency as a criterion for economic policy evaluation. Second, we demonstrate that smoking is associated with several market failures, notably externalities and dependency/addiction (non-rational behavior). Third, costs and benefits of smoking are considered. We argue that the benefits of smoking are the satisfaction (utility) which the consumers derive from it rather than the employment effect of producing tobacco products or the revenues of the excise tax on these products. A general model for estimating the costs of smoking is developed and various cost concepts are discussed. Empirical cost estimates are presented for Switzerland. In 1976, estimated social (economic) costs of smoking were between 560 and 800 million Swiss francs while the external costs were between 140 and 260 million francs. Contrary to a widely held belief, smoking hardly influenced health care costs because the higher medical care costs of smokers during their lifetime are offset by their reduced life expectancy. The last section deals with intervention strategies to reduce smoking: anti-smoking publicity, advertising restrictions, and taxation. We discuss these three instruments on a conceptual level and summarize previous empirical studies. The main results are: (1) Both publicity and taxation offer a considerable potential as deterrents of cigarette demand. (2) The results for Switzerland imply that publicity campaigns are likely to be efficient in the sense that expected campaign benefits outweigh its costs.     

The Effect of Disease, Functional Status, and Relapses on the Utility of People with Multiple Sclerosis in the UK

OBJECTIVES: Because published utility estimates in multiple sclerosis (MS) are concentrated in people with moderate to severe disease severity and focus on specific types of MS, we conducted a cross-sectional study of people with MS to estimate the utility associated with disease, functional status as measured by the Adapted Patient Determined Disease Steps (APDDS) Scale, and relapse to enhance knowledge of the association of these factors and utility. METHODS: The study was conducted by a postal questionnaire sent to 12,968 people in a database managed by a UK charity (the MS Trust). Utility was assessed using the EQ-5D multiattribute utility scale. The APDDS is closely related to the more commonly reported Expanded Disability Status Scale (EDSS). RESULTS: A total of 2708 (20.9%) questionnaires were returned and 2048 (15.8%) respondents provided data suitable for analysis. The mean age of the sample was 51 years, and 22.5% of people were aged 60 years or more. Disease severity was concentrated in people with moderately severe MS (EDSS 4-6.5), with 21%, 60%, and 19% of people reporting mild, moderate, and severe disease, respectively. Results show that disease severity has an inverse relationship with utility. The mean utility is 0.491. Utility varies between 0.870 and -0.195 for EDSS states 0 and 9. Number of years since diagnosis, type of disease, and recent relapse status are also all significantly associated with utility. CONCLUSIONS: The results are comparable with previous published utility estimates. We have demonstrated a clear relationship between functional status, disease type, relapse status, duration of illness, and utility. As a set of coefficients, the utility estimates we have calculated may be used to compare the quality of life of people with MS with other illnesses and to inform future economic evaluations in MS.     

Treatment costs of pneumonia, meningitis, sepsis, and other diseases among hospitalized children in Viet Nam

The aim of this study was to estimate the costs of treatment of children who present with the signs and symptoms of invasive bacterial diseases in Khanh Hoa province, Viet Nam. The study was an incidence-based cost-of-illness analysis from the health system perspective. The hospital costs included labour, materials and capital costs, both direct and indirect. Costs were determined for 980 children, with an average age of 12.67 months (standard deviation +/- 11.38), who were enrolled in a prospective surveillance at the Khanh Hoa General Hospital during 2005-2006. Of them, 57% were male. By disease-category, 80% were suspected of having pneumonia, 8% meningitis, 3% very severe disease consistent with pneumococcal sepsis, and 9% other diseases. Treatment costs for suspected pneumonia, meningitis, very severe disease, and other diseases were US$ 31, US$ 57, US$ 73, and US$ 24 respectively. Costs ranged from US$ 24 to US$ 164 across different case-categories. Both type of disease and age of patient had statistically significant effects on treatment costs. The results showed that treatment costs for bacterial diseases in children were considerable and might differ by as much as seven times among invasive pneumococcal diseases. Changes in costs were sensitive to both age of patient and case-category. These cost-of-illness data will be an important component in the overall evidence base to guide the development of vaccine policy in Viet Nam.     

Skin diseases caused by ultraviolet radiation: the cost of illness

OBJECTIVES: To assess the annual direct and indirect costs of skin diseases caused by ultraviolet radiation. METHODS: A model for cost-of-illness, including costs for hospital care, primary care, pharmaceuticals, mortality, and morbidity, for approximately 1.8 million inhabitants in Stockholm. RESULTS: The total annual discounted cost-of-illness in Stockholm was approximately 162 million SEK (MSEK; approximate 2002 exchange rate: 1 U.S. dollar = 10 SEK). The indirect costs were predominant and constituted approximately 91 MSEK (56% of total costs), mainly due to an estimated cost of mortality for cutaneous malignant melanoma of 84 MSEK. The direct costs of these diseases, approximately 71 MSEK, were predominated by hospital ambulatory care costs of approximately 33 MSEK. The direct costs constituted approximately 0.4% of the overall health-care costs for hospital care and primary health care in the area. CONCLUSIONS: Skin diseases caused by ultraviolet radiation result in moderate economic losses in the community. Therefore, it may not be easy to make successful prevention of these diseases economically beneficial.     

Measuring the time costs of exercise: a proposed measuring method and a pilot study

Background

Alcohol abuse results in problems on various levels in society. In terms of health, alcohol abuse is not only an important risk factor for chronic disease, but it is also related to injuries. Social harms which can be related to drinking include interpersonal problems, work problems, violent and other crimes. The scope of societal costs related to alcohol abuse in principle should be the same for both economic evaluations and cost-of-illness studies. In general, economic evaluations report a small part of all societal costs. To determine the cost- effectiveness of an intervention it is necessary that all costs and benefits are included. The purpose of this study is to describe and quantify the difference in societal costs incorporated in economic evaluations and cost-of-illness studies on alcohol abuse.

Method

To investigate the economic costs attributable to alcohol in cost-of-illness studies we used the results of a recent systematic review (June 2009). We performed a PubMed search to identify economic evaluations on alcohol interventions. Only economic evaluations in which two or more interventions were compared from a societal perspective were included. The proportion of health care costs and the proportion of societal costs were estimated in both type of studies.

Results

The proportion of healthcare costs in cost-of-illness studies was 17% and the proportion of societal costs 83%. In economic evaluations, the proportion of healthcare costs was 57%, and the proportion of societal costs was 43%.

Conclusions

The costs included in economic evaluations performed from a societal perspective do not correspond with those included in cost-of-illness studies. Economic evaluations on alcohol abuse underreport true societal cost of alcohol abuse. When considering implementation of alcohol abuse interventions, policy makers should take into account that economic evaluations from the societal perspective might underestimate the total effects and costs of interventions.     

Direct and Indirect Economic Consequences of Multiple Sclerosis in Ireland

Introduction

Multiple sclerosis (MS) has significant financial consequences for healthcare systems, individual patients and households, and the wider society. This study examines the distribution of MS costs and resource utilisation across cost categories and from various perspectives, as MS disability increases.

Methods

Two hundred and fourteen patients with MS were recruited from a specialist MS outpatient clinic in Ireland and included in an interview-based study on MS-related healthcare resource consumption and costs. Patients were grouped into three categories based on disability: mild [Expanded Disability Status Scale (EDSS) score 0–3.5, n = 114], moderate (EDSS 4.0–6.5, n = 72) and severe (EDSS 7.0–9.5, n = 27). The mean annual direct and indirect costs (in year 2012 values) were estimated using non-parametric bootstrapping.

Results

Participants were 66.4 % female, with a mean age of 47.6 years and a mean EDSS score of 3.6. The majority had relapsing-remitting MS (RRMS) (53 %). The mean annual direct (indirect) costs per person were €10,249 (€9,447), €13,045 (€31,806) and €56,528 (€39,440) in mild, moderate and severe MS, respectively. Direct costs are driven by the cost of disease-modifying therapies and professional home help in mild and severe MS, respectively. Between 74 % (severe MS) and 96 % (mild MS) of all direct costs are borne by the healthcare payer, the remainder being incurred by patients, their families or other non-healthcare organisations.

Conclusions

MS is associated with high levels of healthcare resource consumption and costs, and these costs increase with increasing disability. There is potential to significantly reduce the economic burden of MS through interventions that prevent progression from mild or moderate MS to severe MS, help support independent living at home and keep people with MS in the work force.     

Impact on healthcare resource utilization of multiple sclerosis in Spain

Background

Multiple sclerosis (MS) is a chronic disease with a high socioeconomic impact. The aim of this study was to assess healthcare resources utilization and costs in a sample of patients with MS.

Methods

A retrospective, cohort study was conducted using electronic medical records from 19 primary care centres in Asturias and Catalonia, Spain. Adult patients diagnosed with MS were distributed into two groups according to the Expanded Disability Status Scale (EDSS) score: 0–3.5 (no-moderate disability) and 4–9.5 (severe disability). Healthcare (direct cost) and non-healthcare costs (work productivity losses) were analysed. An analysis of covariance (ANCOVA) was used for correction, p <?0.05. A multiple regression model was performed to obtain the variables associated with costs.

Results

A total of 222 patients were analyzed; mean (SD) age: 45.5 (12.5) years, 64.4% female, and 62.2% presented a diagnosis of relapsing-remitting MS. Median EDSS score was 2.5, with 68.5% of the patients with no to moderate disability. The mean annual cost per MS patient was €25,103. For no-moderate and severe disability, the ANCOVA-adjusted mean annual cost was €23,157 and €29,242, respectively (p =?0.013). Direct costs and MS disease-modifying therapy accounted for 39.4% and 31.7% of the total costs, respectively. The total costs were associated with number of relapses (β?=?0.135, p =?0.001), time since diagnosis (β?=?0.281, p =?0.023), and age (β?=?0.198, p =?0.037).

Conclusions

Multiple sclerosis imposes a substantial economic burden on the Spanish National Health System, patients and society as a whole. Costs significantly correlated with disease progression.

     

The costs of breast cancer prior to and following diagnosis

This retrospective incidence-based cost-of-illness analysis aims to quantify the costs associated with female breast cancer in Flanders for the year prior to diagnosis and for each of the 5 years following diagnosis. A bottom-up analysis from the societal perspective included direct health care costs and indirect costs of productivity loss due to morbidity and premature mortality. A case-control study design compared total costs of breast cancer patients with costs of an equivalent standardised population with a view to calculating the additional costs that can be attributed to breast cancer. Total average costs of breast cancer amounted to 107,456 € per patient over 6 years. Total costs consisted of productivity loss costs (89% of costs) and health care costs (11% of costs). Health care costs did not vary with age at diagnosis. Health care costs of breast cancer patients converged with those of the general population at 5 years following diagnosis. Patients with advanced breast cancer stadia had higher health care costs. Cost estimates provided by this analysis can be used to determine priorities for, and inform, future research on breast cancer. In particular, attention needs to be focussed on decreasing productivity loss from breast cancer.     

When being 'tired of living' plays an important role in a request for euthanasia or physician-assisted suicide: patient characteristics and the physician's decision

BACKGROUND: In the Netherlands physicians are allowed to grant requests for euthanasia or physician-assisted suicide (EAS) if they meet several requirements of due care. According to jurisprudence, a physician is not allowed to end the life of a patient whose request for EAS is based on being 'tired of living', because such a request falls outside the medical domain. Our previous studies have shown that in spite of this, such requests are made approximately 400 times a year. OBJECTIVES: To learn more about patients who request EAS because they are tired of living, and about factors that influence the decision of the physician. DESIGN: Questionnaires (n=4842) completed by general practitioners (n=3994). RESULTS: According to the physicians, 17% of patients who requested EAS were 'tired of living'. Of 139 patients in whose request for EAS being tired of living played a major role, 47% suffered from cancer, 25% suffered from another severe disease and 28% had no severe disease. In all three groups the same three symptoms occurred most frequently, 'feeling bad', 'tired', and 'not active'. Each of these symptoms occurred in more than half of the patients in each group. Most of the requests from patients with cancer were granted, but those from patients who had some other severe disease, or no severe disease at all, were refused. Factors that were related to granting a request were: the presence of unbearable and hopeless suffering, the absence of alternatives, and the absence of depressive symptoms. CONCLUSIONS: Being tired of living can play a major role in requests for EAS, both in the absence and the presence of a severe disease. The high occurrence of symptoms in the absence of a classifiable severe disease implies that physical symptoms are prevalent in this group of patients, leaving the legal requirement for EAS of 'a medical cause' open to interpretation in the more complex medical practice.     

Cost of low back pain in Switzerland in 2005

Low back pain (LBP) is the most prevalent health problem in Switzerland and a leading cause of reduced work performance and disability. This study estimated the total cost of LBP in Switzerland in 2005 from a societal perspective using a bottom-up prevalence-based cost-of-illness approach. The study considers more cost categories than are typically investigated and includes the costs associated with a multitude of LBP sufferers who are not under medical care. The findings are based on a questionnaire completed by a sample of 2,507 German-speaking respondents, of whom 1,253 suffered from LBP in the last 4?weeks; 346 of them were receiving medical treatment for their LBP. Direct costs of LBP were estimated at ??.6?billion and direct medical costs at 6.1% of the total healthcare expenditure in Switzerland. Productivity losses were estimated at ??.1?billion with the human capital approach and ??.2?billion with the friction cost approach. Presenteeism was the single most prominent cost category. The total economic burden of LBP to Swiss society was between 1.6 and 2.3% of GDP.