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Measuring the Cost of Multiple Sclerosis

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Multiple sclerosis (MS) is the most common non-traumatic central nervous system (CNS) disorder of young adults. Prior estimates of the cost of MS were made in 2011 based largely upon a review of the available literature. As the prevalence of MS is greater and the overall system costs larger, it is important to update the economic burden of disease in the U. S.

The National Multiple Sclerosis Society, an organization devoted to finding the cure for MS while empowering patients to live their best lives, commissioned a study to determine the economic burden of the disease in the U.S. Dr. Bruce Bebo, the study’s lead author, presented early results at the 2022 Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) conference. The objectives of the study were to estimate the economic burden of MS in the U.S. in 2019, including both indirect and direct medical costs, lost productivity, and to project the future economic burden of MS through 2039. The study used prevalence estimates of disease to derive direct costs from public/private insurance claims, including prescriber co-pay. Future earnings loss due to premature death were derived from the CDC mortality and Medicare claims data. Non-medical cost estimates were derived from a lengthy survey of 946 patients with MS. 

The study found that the total economic burden of MS in 2019 was $85.4 billion, of which 74% ($63.3 billion) were related to direct medical costs. The remaining 25% ($21 billion) and 1% ($1.1 billion) were related to indirection and non-medical costs, respectively. A further breakdown showed that disease-modifying therapies (DMTs) represent 64% of the direct medical costs, with nearly $42 billion spent on drugs to combat disease. The remaining 26% of direct medical costs were for non-DMT prescription medications, often used as symptomatic therapies, inpatient and outpatient facilities, and physicians and institutional care services. Inpatient and outpatient services, such as hospitalization and long-term care facilities, contributed a little more than $9 billion to the overall direct cost of MS. The study found that indirect or non-medical costs totaled $22.1 billion for 2019, with a little more than $12 billion due to absenteeism or lost work or social productivity and $8 billion due to premature death. Overall, premature death accounted for 38%, absenteeism for 26%, and lost work productivity for 28% of the total non-medical costs. 

A key study aim was to project the future economic burden in 2039. Based upon current estimates, the projected U.S. prevalence of MS in 2039 will be 1.1 million, with the total annual economic impact of disease projected to be $105 billion. 

MS remains a very costly disease, with direct and indirect impacts on the system. Our current DMTs have generally reduced clinical attacks and decreased overall disease burden resulting in longer disability-free periods. However, given that nearly two-thirds of the direct costs were related to DMT, this important study highlights the importance of interventions to control rising drug prices. Additionally, further studies are needed to determine the economic impact of MS in socioeconomically vulnerable persons as racial, ethnic, and gender disparities in health care access relating to diagnosis and treatment are well established. Lastly, as DMT costs differ in the U.S. and other countries, further studies are needed to compare costs between health care systems. 

Dr. Lincoln is employed by McGovern Medical School and UT Health. He has received grants from EMD-Serono, the Department of Defense, and the National Institutes of Health, has received participation fees from Sanofi-Genzyme, and lecturing fees from Biogen and Bristol Myers Squibb.

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