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.