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Published in: The European Journal of Health Economics 7/2016

01-09-2016 | Original Paper

Multiple sclerosis: relapses, resource use, and costs

Authors: A. J. Hawton, C. Green

Published in: The European Journal of Health Economics | Issue 7/2016

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Abstract

Background

Relapses can have a major impact on the lives of people with multiple sclerosis (MS), and yet relapse-related healthcare costs have received little attention. This has limited cost-effectiveness analyses of treatments for MS and hampered decision-making regarding the funding of MS healthcare services.

Objective

To describe health/social care resource use and costs according to the frequency, severity, and endurance of MS relapses.

Methods

Data from the prospective, longitudinal UK South West Impact of Multiple Sclerosis cohort were used. A total of 11,800 questionnaires from 1441 people with MS were available, including data on relapses, contacts with health/social care professionals, and other MS-related resource use.

Results

The mean (SD) 6-monthly MS-related health/social care cost for individuals who reported a relapse was £519 (£949), compared to £229 (£366) for those who had not did report a relapse. Care costs varied widely dependent on the characteristics of the relapse. The mean (SD) cost when a relapse was not treated with steroids was £381 (£780), whilst the equivalent cost was £3579 (£1727) when a relapse resulted in hospitalization.

Conclusions

The impact of relapses on health and social care resources and costs differs according to their frequency, length, and severity. The data provided here can be used in cost-effectiveness analyses and to inform decision-making regarding healthcare provision for people with this condition.
Literature
1.
go back to reference Hauser, S.: Multiple sclerosis and other demyelinating diseases. In: Isselbacher, K., Braunwald, E., Wilson, J. (eds.) Harrison’s Principles of Internal Medicine. McGraw-Hill, New York (1994) Hauser, S.: Multiple sclerosis and other demyelinating diseases. In: Isselbacher, K., Braunwald, E., Wilson, J. (eds.) Harrison’s Principles of Internal Medicine. McGraw-Hill, New York (1994)
2.
go back to reference Noseworthy, J., Lucchinetti, C., Rodriguez, M., Weinshenker, B.: Medical progress: multiple sclerosis. N. Engl. J. Med. 343, 938–952 (2000)CrossRefPubMed Noseworthy, J., Lucchinetti, C., Rodriguez, M., Weinshenker, B.: Medical progress: multiple sclerosis. N. Engl. J. Med. 343, 938–952 (2000)CrossRefPubMed
3.
go back to reference Multiple Sclerosis International Federation: Atlas of MS 2013. Multiple Sclerosis International Federation, London (2013) Multiple Sclerosis International Federation: Atlas of MS 2013. Multiple Sclerosis International Federation, London (2013)
4.
go back to reference Kobelt, G., Berg, J., Lindgren, P., Anten, B., Ekman, M., Jongen, P.J.H., Polman, C., Uitdehaag, B.: Costs and quality of life in multiple sclerosis in The Netherlands. Eur. J. Health. Econ. 7(2 SUPPL.), S55–S64 (2006)CrossRefPubMed Kobelt, G., Berg, J., Lindgren, P., Anten, B., Ekman, M., Jongen, P.J.H., Polman, C., Uitdehaag, B.: Costs and quality of life in multiple sclerosis in The Netherlands. Eur. J. Health. Econ. 7(2 SUPPL.), S55–S64 (2006)CrossRefPubMed
5.
go back to reference Kobelt, G., Berg, J., Lindgren, P., Battaglia, M., Lucioni, C., Uccelli, A.: Costs and quality of life of multiple sclerosis in Italy. Eur. J. Health. Econ. 7(2 SUPPL.), S45–S54 (2006)CrossRefPubMed Kobelt, G., Berg, J., Lindgren, P., Battaglia, M., Lucioni, C., Uccelli, A.: Costs and quality of life of multiple sclerosis in Italy. Eur. J. Health. Econ. 7(2 SUPPL.), S45–S54 (2006)CrossRefPubMed
6.
go back to reference Kobelt, G., Berg, J., Lindgren, P., Berger, K., Elias, W.G., Flachenecker, P., Freidel, M., Konig, N., Limmroth, V., Straube, E.: Costs and quality of life of multiple sclerosis in Germany. Eur. J. Health. Econ. 7(2 SUPPL.), S34–S44 (2006)CrossRefPubMed Kobelt, G., Berg, J., Lindgren, P., Berger, K., Elias, W.G., Flachenecker, P., Freidel, M., Konig, N., Limmroth, V., Straube, E.: Costs and quality of life of multiple sclerosis in Germany. Eur. J. Health. Econ. 7(2 SUPPL.), S34–S44 (2006)CrossRefPubMed
7.
go back to reference Kobelt, G., Berg, J., Lindgren, P., Decoo, D., Guillaume, D., Neymark, N., Sindic, C., Vandegaer, L.: Costs and quality of life for patients with multiple sclerosis in Belgium. Eur. J. Health. Econ. 7(2 Suppl.), S24–S33 (2006)CrossRefPubMed Kobelt, G., Berg, J., Lindgren, P., Decoo, D., Guillaume, D., Neymark, N., Sindic, C., Vandegaer, L.: Costs and quality of life for patients with multiple sclerosis in Belgium. Eur. J. Health. Econ. 7(2 Suppl.), S24–S33 (2006)CrossRefPubMed
8.
go back to reference Kobelt, G., Berg, J., Lindgren, P., Gerfin, A., Lutz, J.: Costs and quality of life of multiple sclerosis in Switzerland. Eur. J. Health. Econ. 7(2 Suppl.), S86–S95 (2006)CrossRefPubMed Kobelt, G., Berg, J., Lindgren, P., Gerfin, A., Lutz, J.: Costs and quality of life of multiple sclerosis in Switzerland. Eur. J. Health. Econ. 7(2 Suppl.), S86–S95 (2006)CrossRefPubMed
9.
go back to reference Kobelt, G., Berg, J., Lindgren, P., Izquierdo, G., Sanchez-Solino, O., Perez-Miranda, J., Casado, M.A.: Costs and quality of life of multiple sclerosis in Spain. Eur. J. Health. Econ. 7(2 Suppl.), S65–S74 (2006)CrossRefPubMed Kobelt, G., Berg, J., Lindgren, P., Izquierdo, G., Sanchez-Solino, O., Perez-Miranda, J., Casado, M.A.: Costs and quality of life of multiple sclerosis in Spain. Eur. J. Health. Econ. 7(2 Suppl.), S65–S74 (2006)CrossRefPubMed
10.
go back to reference Kobelt, G., Berg, J., Lindgren, P., Kerrigan, J., Russell, N., Nixon, R.: Costs and quality of life of multiple sclerosis in the United Kingdom. Eur. J. Health. Econ. 7(Suppl 2), S96–S104 (2006)CrossRefPubMed Kobelt, G., Berg, J., Lindgren, P., Kerrigan, J., Russell, N., Nixon, R.: Costs and quality of life of multiple sclerosis in the United Kingdom. Eur. J. Health. Econ. 7(Suppl 2), S96–S104 (2006)CrossRefPubMed
11.
go back to reference Kobelt, G., Berg, J., Lindgren, P., Plesnilla, C., Baumhackl, U., Berger, T., Kolleger, H., Vass, K.: Costs and quality of life of multiple sclerosis in Austria. Eur. J. Health. Econ. 7(Suppl 2), S14–S23 (2006)CrossRefPubMed Kobelt, G., Berg, J., Lindgren, P., Plesnilla, C., Baumhackl, U., Berger, T., Kolleger, H., Vass, K.: Costs and quality of life of multiple sclerosis in Austria. Eur. J. Health. Econ. 7(Suppl 2), S14–S23 (2006)CrossRefPubMed
12.
go back to reference Berg, J., Lindgren, P., Fredrikson, S., Kobelt, G.: Costs and quality of life of multiple sclerosis in Sweden. Eur. J. Health. Econ. 7(Suppl 2), S75–S85 (2006)CrossRefPubMed Berg, J., Lindgren, P., Fredrikson, S., Kobelt, G.: Costs and quality of life of multiple sclerosis in Sweden. Eur. J. Health. Econ. 7(Suppl 2), S75–S85 (2006)CrossRefPubMed
13.
go back to reference Kobelt, G., Berg, J., Lindgren, P., Fredrikson, S., Jo¨nsson, B.: Costs and quality of life of patients with multiple sclerosis in Europe. J. Neurol. Neurosurg. Psychiatry. 77, 918–926 (2006)CrossRefPubMedPubMedCentral Kobelt, G., Berg, J., Lindgren, P., Fredrikson, S., Jo¨nsson, B.: Costs and quality of life of patients with multiple sclerosis in Europe. J. Neurol. Neurosurg. Psychiatry. 77, 918–926 (2006)CrossRefPubMedPubMedCentral
14.
go back to reference McCrone, P., Heslin, M., Knapp, M., Bull, P., Thompson, A.: Multiple sclerosis in the UK: Service use, costs, quality of life and disability. Pharmacoeconomics. 26(10), 847–860 (2008)CrossRefPubMed McCrone, P., Heslin, M., Knapp, M., Bull, P., Thompson, A.: Multiple sclerosis in the UK: Service use, costs, quality of life and disability. Pharmacoeconomics. 26(10), 847–860 (2008)CrossRefPubMed
15.
go back to reference National Institute for Clinical Excellence: Beta Interferon and Glatarimer Acetate for the Treatment of Multiple Sclerosis. Guidance No. 32. National Institute for Clinical Excellence, London (2002) National Institute for Clinical Excellence: Beta Interferon and Glatarimer Acetate for the Treatment of Multiple Sclerosis. Guidance No. 32. National Institute for Clinical Excellence, London (2002)
16.
go back to reference National Institute for Health and Clinical Excellence: Natalizumab for the Treatment of Adults with Highly Active Relapsing-Remitting Multiple Sclerosis. Guidance No. TA127. National Institute for Health and Clinical Excellence, London (2007) National Institute for Health and Clinical Excellence: Natalizumab for the Treatment of Adults with Highly Active Relapsing-Remitting Multiple Sclerosis. Guidance No. TA127. National Institute for Health and Clinical Excellence, London (2007)
17.
go back to reference National Institute for Health and Clinical Excellence: Fingolimod for the Treatment of Highly Active Relapsing-Remitting Multiple Sclerosis. TA254. National Institute for Health and Clinical Excellence, London (2012) National Institute for Health and Clinical Excellence: Fingolimod for the Treatment of Highly Active Relapsing-Remitting Multiple Sclerosis. TA254. National Institute for Health and Clinical Excellence, London (2012)
18.
go back to reference McCabe, C., Chilcott, J., Claxton, K., Tappenden, P., Cooper, C., Roberts, J., Cooper, N., Abrams, K.: Continuing the multiple sclerosis risk sharing scheme is unjustified. BMJ 340, c1786 (2010)CrossRefPubMed McCabe, C., Chilcott, J., Claxton, K., Tappenden, P., Cooper, C., Roberts, J., Cooper, N., Abrams, K.: Continuing the multiple sclerosis risk sharing scheme is unjustified. BMJ 340, c1786 (2010)CrossRefPubMed
19.
go back to reference Chilcott, J., McCabe, C., Tappenden, P., O’Hagan, A., Cooper, N.J., Abrams, K., Claxton, K.: Modelling the cost effectiveness of interferon beta and glatiramer acetate in the management of multiple sclerosis. BMJ 326(7388), 522–525 (2003)CrossRefPubMedPubMedCentral Chilcott, J., McCabe, C., Tappenden, P., O’Hagan, A., Cooper, N.J., Abrams, K., Claxton, K.: Modelling the cost effectiveness of interferon beta and glatiramer acetate in the management of multiple sclerosis. BMJ 326(7388), 522–525 (2003)CrossRefPubMedPubMedCentral
20.
21.
go back to reference Hawton, A., Shearer, J., Goodwin, E., Green, C.: Squinting through layers of fog: assessing the cost effectiveness of treatments for multiple sclerosis. Appl. Health. Econ. Health. Policy. 11, 331–341 (2013)CrossRefPubMed Hawton, A., Shearer, J., Goodwin, E., Green, C.: Squinting through layers of fog: assessing the cost effectiveness of treatments for multiple sclerosis. Appl. Health. Econ. Health. Policy. 11, 331–341 (2013)CrossRefPubMed
22.
go back to reference Owens, T., Evangelou, N., Whynes, D.: Rationing and deprivation: disease-modifying therapies for multiple sclerosis in the United Kingdom. Eur. J. Health. Econ. 14, 315–321 (2013)CrossRefPubMed Owens, T., Evangelou, N., Whynes, D.: Rationing and deprivation: disease-modifying therapies for multiple sclerosis in the United Kingdom. Eur. J. Health. Econ. 14, 315–321 (2013)CrossRefPubMed
23.
go back to reference Zajicek, J., Ingram, W., Vickery, J., Creanor, S., Wright, D., Hobart, J.: Patient-orientated longitudinal study of multiple sclerosis in south west England (The South West Impact of Multiple Sclerosis Project, SWIMS 1: protocol and baseline characteristics of cohort. BMC. Neurol 10, 88 (2010)CrossRefPubMedPubMedCentral Zajicek, J., Ingram, W., Vickery, J., Creanor, S., Wright, D., Hobart, J.: Patient-orientated longitudinal study of multiple sclerosis in south west England (The South West Impact of Multiple Sclerosis Project, SWIMS 1: protocol and baseline characteristics of cohort. BMC. Neurol 10, 88 (2010)CrossRefPubMedPubMedCentral
24.
go back to reference Zajicek, J., Freeman, J., Porter, B.: Multiple Sclerosis: A Practical Manual. Oxford University Press, Oxford (2007)CrossRef Zajicek, J., Freeman, J., Porter, B.: Multiple Sclerosis: A Practical Manual. Oxford University Press, Oxford (2007)CrossRef
25.
go back to reference Oleen-Burkey, M., Castelli-Haley, J., Lage, M., Johnson, K.: Burden of a multiple sclerosis relapse: the patient’s perspective. Patient 5(1), 57–69 (2012)CrossRefPubMed Oleen-Burkey, M., Castelli-Haley, J., Lage, M., Johnson, K.: Burden of a multiple sclerosis relapse: the patient’s perspective. Patient 5(1), 57–69 (2012)CrossRefPubMed
26.
go back to reference Poser, C., Paty, D., Scheinburg, L.: New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann. Neurol. 13, 227–231 (1983)CrossRefPubMed Poser, C., Paty, D., Scheinburg, L.: New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann. Neurol. 13, 227–231 (1983)CrossRefPubMed
27.
go back to reference Confavreux, C., Compston, A.: The Natural history of Multiple Sclerosis. In: McAlpine’s Multiple Sclerosis. Churchill Livingstone Elsevier, Philadelphia (2006) Confavreux, C., Compston, A.: The Natural history of Multiple Sclerosis. In: McAlpine’s Multiple Sclerosis. Churchill Livingstone Elsevier, Philadelphia (2006)
28.
go back to reference Tyas, D., Kerrigan, J., Russell, N., Nixon, R.: The distribution of the cost of multiple sclerosis in the UK: how do costs vary by illness severity? Value. Health. 10(5), 386–389 (2007)CrossRefPubMed Tyas, D., Kerrigan, J., Russell, N., Nixon, R.: The distribution of the cost of multiple sclerosis in the UK: how do costs vary by illness severity? Value. Health. 10(5), 386–389 (2007)CrossRefPubMed
29.
go back to reference Patwardhan, M., Matchar, D., Samsa, G., McCrory, D., Williams, R., Li, T.: Cost of multiple sclerosis by level of disability: a review of literature. Mult. Scler. 11, 232–239 (2005)CrossRefPubMed Patwardhan, M., Matchar, D., Samsa, G., McCrory, D., Williams, R., Li, T.: Cost of multiple sclerosis by level of disability: a review of literature. Mult. Scler. 11, 232–239 (2005)CrossRefPubMed
30.
go back to reference O’Brien, J., Ward, A., Patrick, A., et al.: Cost of managing an episode or relapse in multiple sclerosis in the United States. BMC. Health. Serv. Res. 3(1), 17 (2003)CrossRefPubMedPubMedCentral O’Brien, J., Ward, A., Patrick, A., et al.: Cost of managing an episode or relapse in multiple sclerosis in the United States. BMC. Health. Serv. Res. 3(1), 17 (2003)CrossRefPubMedPubMedCentral
31.
go back to reference Amato, M., Battaglia, M., Caputo, D., Fattore, G., Gerzeli, S., Pitaro, M., Reggio, R., Trajano, M.: The costs of multiple sclerosis: a cross-sectional, multi-center, cost-of-illness study in Italy. J. Neurol. 249, 152–163 (2002)CrossRefPubMed Amato, M., Battaglia, M., Caputo, D., Fattore, G., Gerzeli, S., Pitaro, M., Reggio, R., Trajano, M.: The costs of multiple sclerosis: a cross-sectional, multi-center, cost-of-illness study in Italy. J. Neurol. 249, 152–163 (2002)CrossRefPubMed
32.
go back to reference Parkin, D., Jacoby, A., McNamee, P., Miller, P., Thomas, S., Bates, D.: Treatment of multiple sclerosis with interferon beta: An appraisal of cost-effectiveness and quality of life. J. Neurol. Neurosurg. Psychiatry. 68(2), 144–149 (2000)CrossRefPubMedPubMedCentral Parkin, D., Jacoby, A., McNamee, P., Miller, P., Thomas, S., Bates, D.: Treatment of multiple sclerosis with interferon beta: An appraisal of cost-effectiveness and quality of life. J. Neurol. Neurosurg. Psychiatry. 68(2), 144–149 (2000)CrossRefPubMedPubMedCentral
33.
go back to reference Grima, D.T., Torrance, G.W., Francis, G., Rice, G., Rosner, A.J., Lafortune, L.: Cost and health related quality of life consequences of multiple sclerosis. Mult Scler 6(2), 91–98 (2000)CrossRefPubMed Grima, D.T., Torrance, G.W., Francis, G., Rice, G., Rosner, A.J., Lafortune, L.: Cost and health related quality of life consequences of multiple sclerosis. Mult Scler 6(2), 91–98 (2000)CrossRefPubMed
34.
go back to reference Naci, H., Fleurence, R., Birt, J., Duhig, A.: Economic burden of multiple sclerosis. a systematic review of the literature. Pharmacoeconomics 28(5), 363–379 (2010)CrossRefPubMed Naci, H., Fleurence, R., Birt, J., Duhig, A.: Economic burden of multiple sclerosis. a systematic review of the literature. Pharmacoeconomics 28(5), 363–379 (2010)CrossRefPubMed
35.
go back to reference Orme, M., Kerrigan, J., Tyas, D., Russell, N., Nixon, R.: The effect of disease, functional status, and relapses on the utility of people with multiple sclerosis in the UK. Value. Health. 10(1), 54–60 (2007)CrossRefPubMed Orme, M., Kerrigan, J., Tyas, D., Russell, N., Nixon, R.: The effect of disease, functional status, and relapses on the utility of people with multiple sclerosis in the UK. Value. Health. 10(1), 54–60 (2007)CrossRefPubMed
36.
go back to reference Zajicek, J., Ingram, W., Vickery, J., Creanor, S., Wright, D., Hobart, J.: Patient-orientated longitudinal study of multiple sclerosis in south west England (The South West Impact of Multiple Sclerosis Project, SWIMS) 1: protocol and baseline characteristics of cohort. BMC. Neurol. 10, 88 (2010)CrossRefPubMedPubMedCentral Zajicek, J., Ingram, W., Vickery, J., Creanor, S., Wright, D., Hobart, J.: Patient-orientated longitudinal study of multiple sclerosis in south west England (The South West Impact of Multiple Sclerosis Project, SWIMS) 1: protocol and baseline characteristics of cohort. BMC. Neurol. 10, 88 (2010)CrossRefPubMedPubMedCentral
37.
go back to reference Kurtzke, J.: Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33, 1444–1452 (1983)CrossRefPubMed Kurtzke, J.: Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33, 1444–1452 (1983)CrossRefPubMed
38.
go back to reference Curtis, L.: Unit Costs of Health and Social Care 2013. Personal Social Services Research Unit. University of Kent, Canterbury (2013) Curtis, L.: Unit Costs of Health and Social Care 2013. Personal Social Services Research Unit. University of Kent, Canterbury (2013)
39.
go back to reference Department of Health: Reference Costs 2011–12. Department of Health, London (2012) Department of Health: Reference Costs 2011–12. Department of Health, London (2012)
41.
go back to reference Fox, C., Bensa, S., Bray, I., Zajicek, J.: The epidemiology of multiple sclerosis in Devon: a comparison of new and old classification criteria. J. Neurol. Neurosurg. Psychiatry. 75, 56–60 (2004)PubMedPubMedCentral Fox, C., Bensa, S., Bray, I., Zajicek, J.: The epidemiology of multiple sclerosis in Devon: a comparison of new and old classification criteria. J. Neurol. Neurosurg. Psychiatry. 75, 56–60 (2004)PubMedPubMedCentral
42.
go back to reference Robertson, N., Deans, J., Fraser, M., et al.: Multiple sclerosis in the North Cambridgeshire districts of East Anglia. J. Neurol. Neurosurg. Psychiatry. 59, 71–76 (1995)CrossRefPubMedPubMedCentral Robertson, N., Deans, J., Fraser, M., et al.: Multiple sclerosis in the North Cambridgeshire districts of East Anglia. J. Neurol. Neurosurg. Psychiatry. 59, 71–76 (1995)CrossRefPubMedPubMedCentral
43.
go back to reference Ford, H., Gerry, E., Airey, C., et al.: The prevalence of multiple sclerosis in the Leeds Health Authority. J. Neurol. Neurosurg. Psychiatry. 64, 605–610 (1998)CrossRefPubMedPubMedCentral Ford, H., Gerry, E., Airey, C., et al.: The prevalence of multiple sclerosis in the Leeds Health Authority. J. Neurol. Neurosurg. Psychiatry. 64, 605–610 (1998)CrossRefPubMedPubMedCentral
44.
go back to reference Forbes, R.B., Wilson, S., Swingler, R.J.: The prevalence of multiple sclerosis in Tayside, Scotland: do latitudinal gradients really exist? J. Neurol. 246, 1033–1040 (1999)CrossRefPubMed Forbes, R.B., Wilson, S., Swingler, R.J.: The prevalence of multiple sclerosis in Tayside, Scotland: do latitudinal gradients really exist? J. Neurol. 246, 1033–1040 (1999)CrossRefPubMed
45.
go back to reference McDonnell, G., Hawkins, S.: An epidemiologic study of multiple sclerosis in Northern Ireland. Neurology 50, 423–428 (1998)CrossRefPubMed McDonnell, G., Hawkins, S.: An epidemiologic study of multiple sclerosis in Northern Ireland. Neurology 50, 423–428 (1998)CrossRefPubMed
46.
go back to reference Forbes, R.B., Swingler, R.J., Hawkins, S., et al.: An epidemiological study of multiple sclerosis in Northern Ireland. Neurology 52, 214–218 (1999)CrossRef Forbes, R.B., Swingler, R.J., Hawkins, S., et al.: An epidemiological study of multiple sclerosis in Northern Ireland. Neurology 52, 214–218 (1999)CrossRef
47.
go back to reference Ford, D., Jones, K., Middleton, R., Lockhart-Jones, H., Maramba, I., Noble, G., Osborne, L., Lyons, R.: The feasibility of collecting information from people with Multiple Sclerosis for the UK MS Register via a web portal: characterising a cohort of people with MS. BMC. Med. Inform. Decis. Mak. 12, 73 (2012)CrossRefPubMedPubMedCentral Ford, D., Jones, K., Middleton, R., Lockhart-Jones, H., Maramba, I., Noble, G., Osborne, L., Lyons, R.: The feasibility of collecting information from people with Multiple Sclerosis for the UK MS Register via a web portal: characterising a cohort of people with MS. BMC. Med. Inform. Decis. Mak. 12, 73 (2012)CrossRefPubMedPubMedCentral
48.
go back to reference Kobelt, G., Berg, J., Lindgren, P., Jonsson, B.: Costs and quality of life in multiple sclerosis in Europe: method of assessment and analysis. Eur. J. Health. Econ. 7(Suppl 2), S5–S13 (2006)CrossRefPubMed Kobelt, G., Berg, J., Lindgren, P., Jonsson, B.: Costs and quality of life in multiple sclerosis in Europe: method of assessment and analysis. Eur. J. Health. Econ. 7(Suppl 2), S5–S13 (2006)CrossRefPubMed
Metadata
Title
Multiple sclerosis: relapses, resource use, and costs
Authors
A. J. Hawton
C. Green
Publication date
01-09-2016
Publisher
Springer Berlin Heidelberg
Published in
The European Journal of Health Economics / Issue 7/2016
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-015-0728-3

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