Peter Lindgren

Costs and quality of life of patients with multiple sclerosis in Europe

Objective: To assess overall resource consumption, work capacity and quality of life of patients with multiple sclerosis in nine European countries. Methods: Information on resource consumption related to multiple sclerosis, informal care by relatives, productivity losses and overall quality of life (utility) was collected with a standardised pre-tested questionnaire from 13 186 patients enrolled in national multiple sclerosis societies or followed up in neurology clinics. Information on disease included disease duration, self-assessed disease severity and relapses. Mean annual costs per patient (€, 2005) were estimated from the societal perspective. Results: The mean age ranged from 45.1 to 53.4 years, and all levels of disease severity were represented. Between 16% and 29% of patients reported experiencing a relapse in the 3 months preceding data collection. The proportion of patients in early retirement because of multiple sclerosis ranged from 33% to 45%. The use of direct medical resources (eg, hospitalisation, consultations and drugs) varied considerably across countries, whereas the use of non-medical resources (eg, walking sticks, wheel chairs, modifications to house and car) and services (eg, home care and transportation) was comparable. Informal care use was highly correlated with disease severity, but was further influenced by healthcare systems and family structure. All types of costs increased with worsening disease. The total mean annual costs per patient (adjusted for gross domestic product purchasing power) were estimated at €18 000 for mild disease (Expanded Disability Status Scale (EDSS) <4.0), €36 500 for moderate disease (EDSS 4.0–6.5) and €62 000 for severe disease (EDSS >7.0). Utility was similar across countries at around 0.70 for a patient with an EDSS of 2.0 and around 0.45 for a patient with an EDSS of 6.5. Intangible costs were estimated at around €13 000 per patient.

Costs of atrial fibrillation in five European countries: results from the Euro Heart Survey on atrial fibrillation

AIMS To estimate costs of admission and costs incurred on an annual basis by patients with atrial fibrillation (AF) in Greece, Italy, Poland, Spain, and the Netherlands. METHODS AND RESULTS The Euro Heart Survey on AF enrolled 5333 patients with AF in 35 European countries in 2003 and 2004. This was a bottom-up cost study conducted for the five largest contributors in terms of patients enrolled. Quantities of resource use during the enrolment admission and during 1-year follow-up were inferred from survey data and multiplied by national unit costs in order to estimate per patient costs associated with AF for each country. Mean costs of inpatient admission of an AF patient were estimated at euro1363, euro5252, euro2322, euro6360, and euro6445 and mean costs incurred on an annual basis at euro1507, euro3225, euro1010, euro2315, and euro2328 in Greece, Italy, Poland, Spain, and the Netherlands, respectively. Inpatient care and interventional procedures were identified as the main drivers of costs, accounting for more than 70% of total annual costs in all five countries. CONCLUSION Estimates of the economic burden posed by AF are critical in light of the increasing importance of AF as a public health problem.

Costs and quality of life of multiple sclerosis in Germany

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.

The cost-effectiveness of donepezil therapy in Swedish patients with Alzheimer's disease: A Markov model

This study compared the cost-effectiveness of donepezil, a new cholinesterase inhibitor indicated for the treatment of mild-to-moderate probable Alzheimers disease (AD), with no treatment. A Markov state transition model was employed to simulate treatment costs based on Swedish epidemiologic data. The Markov states used in the model were defined according to cognitive function, as assessed by the Mini-Mental State Examination. Data on costs and baseline transition probabilities were taken from the Kungsholmen Project, an observational, population-based study of persons aged >75 years in Sweden. Data on the treatment effect were taken from a clinical trial comparing donepezil to placebo over 24 weeks and were applied to the baseline transition probabilities to assess the effect of treating the clinical manifestations of AD in Swedish patients. Also, a within-trial analysis was performed for comparison, using transition probabilities taken from the clinical study. Both models were run for 5 years in half-year cycles, and both demonstrated various degrees of cost savings and improved effectiveness, as measured by increased time in nonsevere disease states. Thus donepezil had superior cost-effectiveness compared with no treatment.

Cost effectiveness of etanercept (Enbrel) in combination with methotrexate in the treatment of active rheumatoid arthritis based on the TEMPO trial

Objective: To estimate the cost effectiveness of combination treatment with etanercept plus methotrexate in comparison with monotherapies in patients with active rheumatoid arthritis (RA) using a new model that incorporates both functional status and disease activity. Methods: Effectiveness data were based on a 2 year trial in 682 patients with active RA (TEMPO). Data on resource consumption and utility related to function and disease activity were obtained from a survey of 616 patients in Sweden. A Markov model was constructed with five states according to functional status (Health Assessment Questionnaire (HAQ)) subdivided into high and low disease activity. The cost for each quality adjusted life year (QALY) gained was estimated by Monte Carlo simulation. Results: Disease activity had a highly significant effect on utilities, independently of HAQ. For resource consumption, only HAQ was a significant predictor, with the exception of sick leave. Compared with methotrexate alone, etanercept plus methotrexate over 2 years increased total costs by €14 221 and led to a QALY gain of 0.38. When treatment was continued for 10 years, incremental costs were €42 148 for a QALY gain of 0.91. The cost per QALY gained was €37 331 and €46 494, respectively. The probability that the cost effectiveness ratio is below a threshold of €50 000/QALY is 88%. Conclusion: Incorporating the influence of disease activity into this new model allows better assessment of the effects of anti-tumour necrosis factor treatment on patients’ general wellbeing. In this analysis, the cost per QALY gained with combination treatment with etanercept plus methotrexate compared with methotrexate alone falls within the acceptable range.

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.

Cost of Parkinson's disease in Europe.

P Lindgren, S. von Campenhausen, Ea Spottke, U Siebert and R Dodel Stockholm Health Economics, Stockholm, Sweden and Department of Cardiovascular Epidemiology, Karolinska Institutet, Stockholm, Sweden; Department of Neurology, Friedrich-Wilhelms-University Bonn, Germany; Institute for Technology Assessment and Department of Radiology, Massachussetts General Hospital, Harvard Medical School, Boston, USA

COSTS OF MINI MENTAL STATE EXAMINATION-RELATED COGNITIVE IMPAIRMENT

AbstractObjective: To investigate the relationship between cognitive impairment, measured with the Mini Mental State Examination (MMSE), and the cost of care. Design: The study uses data from the Kungsholmen project, a population-based study in Sweden in which people 75 years and older were observed over time. The initial study population (n = 1810) was divided into 4 health states based on the MMSE. A Markov model was constructed from the transition probabilities between different states between the first and second phases of the study. The expected cost of cognitive impairment for a period of 10 years was estimated for the cohort of patients studied. Main outcome measures and results: There was a strong correlation between cognitive impairment in terms of the MMSE and the annual cost of care. A multivariate statistical analysis showed that a decrease in the MMSE by 1 point was associated with an increase in the cost of care of 15 000 Swedish kronor (SEK) [

The burden of Duchenne muscular dystrophy: An international, cross-sectional study

US2000; 1995 values]. Conclusions: The results show that large savings are possible if the decline in cognitive functioning can be prevented. The model developed can be used to estimate the impact on cost of care of treatments which reduce the cognitive decline in patients with Alzheimer’s disease.

Prevalence and incidence of Type 2 diabetes and its complications 1996-2003-estimates from a Swedish population-based study

Objective: The objective of this study was to estimate the total cost of illness and economic burden of Duchenne muscular dystrophy (DMD). Methods: Patients with DMD from Germany, Italy, United Kingdom, and United States were identified through Translational Research in Europe–Assessment & Treatment of Neuromuscular Diseases registries and invited to complete a questionnaire online together with a caregiver. Data on health care use, quality of life, work status, informal care, and household expenses were collected to estimate costs of DMD from the perspective of society and caregiver households. Results: A total of 770 patients (173 German, 122 Italian, 191 from the United Kingdom, and 284 from the United States) completed the questionnaire. Mean per-patient annual direct cost of illness was estimated at between