Health care costs and disease severity of relapsing-remitting multiple sclerosis in Portugal

Objective: In Portugal, the prevalence rate for multiple sclerosis (MS) has been estimated at 47 per 100,000 population and there are around 700 annual MS inpatient episodes in public hospitals. Though the number of patients is small, the costs to the health system are potentially large. The present study measures the average health care cost per patient with relapsing remitting multiple sclerosis (RRMS) by level of severity in Portugal. Additionally, and in contrast to previous studies, the health care cost of a relapse by severity level is also calculated. Methods: The study adopts the perspective of the National Health Service (NHS) and carries out a cost of care analysis. Information concerning treatment profiles and resource use was gathered through a modified Delphi Panel involving seven experienced neurologists and a physiatrician from eight hospitals throughout the country. Each completed a questionnaire based on four clinical cases chosen to represent different levels of the Expanded Disability Severity Scale (EDSS). Information was collected on the use of inpatient care, pharmaceuticals, ambulatory visits, diagnostic tests, therapeutic procedures, nursing and other resources. Resources were valued using national information on unit costs from a variety of sources. Results: Total health care costs per patient, in 2003, were estimated to range from _11,515 (EDSS less or equal (LE) 3) to _22,876 (EDSS greater or equal (GE) 6.5). At each level of EDSS the cost of care rises with the most significant increase occurring between EDSS LE 3 and EDSS 3.5 /4.5. The highest expenditures are associated with the use of interferons (between 44% and 82% of the total costs), followed by inpatient care or ambulatory care, depending on the level of severity. When patients have a relapse, health care costs vary between _3,412 (EDSS LE 3) and _6,718 (EDSS GE 6.5). At intermediate EDSS levels the costs of a relapse are _4,422 for EDSS 3.5 /4.5 and _6,495 for EDSS 5 /6. The most significant cost component for relapses is that related to inpatient stays followed by ambulatory care. Conclusion: In Portugal around 5,000 people suffer from MS. The disease imposes enormous costs on the health service. Therapeutic strategies that reduce the impact of the disease (eg. relapse avoidance) can bring about potentially significant cost-savings. The results may be used as input to cost-effectiveness analyses and more widely in health care planning and policy