Περίληψη:
Background and aims: The economic consequences of multiple sclerosis (MS) are broader than those observed within the health system. The progressive nature suggests that people will not be able to live a normal productive life and will gradually require public benefits to maintain living standards. This study investigates the public economic impact of MS and how investments in disease-modifying therapies (DMTs) influence the lifetime costs to government attributed to changes in lifetime tax revenue and disability benefits based on improved health status linked to delayed disease progression. Methods: Disease progression rates from previous MS Markov cohort models were applied to interferon beta-1a, peginterferon beta-1a, dimethyl fumarate, and natalizumab using a public economic framework. The established relationship between expanded disability status scale and work-force participation, annual earnings, and disability rates for each DMT were applied. Subsequently, we assessed the effect of DMTs on discounted governmental costs consisting of health service costs, social insurance and disability costs, and changes in lifetime tax revenues. Results: Fiscal benefits attributed to informal care and community services savings for interferon beta-1a, peginterferon beta-1a, dimethyl fumarate, and natalizumab were SEK340,387, SEK486,837, SEK257,330, and SEK958,852 compared to placebo, respectively. Tax revenue gains linked to changes in lifetime productivity for interferon beta-1a, peginterferon beta-1a, dimethyl fumarate, and natalizumab were estimated to be SEK27,474, SEK39,659, SEK21,661, and SEK75,809, with combined fiscal benefits of cost savings and tax revenue increases of SEK410,039, SEK596,592, SEK326,939, and SEK1,208,023, respectively. Conclusion: The analysis described here illustrates the broader public economic benefits for government attributed to changes in disease status. The lifetime social insurance transfer costs were highest in non-treated patients, and lower social insurance costs were demonstrated with DMTs. These findings suggest that focusing cost-effectiveness analysis only on health costs will likely underestimate the value of DMTs. © 2020 University of Groningen. Published by Informa UK Limited, trading as Taylor & Francis Group.
Συγγραφείς:
Kotsopoulos, N.
Connolly, M.P.
Dort, T.
Kavaliunas, A.
Λέξεις-κλειδιά:
beta1a interferon; fumaric acid dimethyl ester; natalizumab; peginterferon beta1a; beta interferon; beta1a interferon; dimethyl fumarate; immunosuppressive agent; macrogol; natalizumab; peginterferon beta1a, Article; cost control; cost effectiveness analysis; disease exacerbation; Expanded Disability Status Scale; health care cost; health service; health status; human; income; investment; mortality; multiple sclerosis; public health; recurrence risk; relapse; social insurance; social welfare; Sweden; tax; treatment outcome; workforce; caregiver; cost benefit analysis; cost of illness; economic model; economics; government; health economics; Markov chain; medical leave; multiple sclerosis; productivity; public health; social work, Caregivers; Cost of Illness; Cost-Benefit Analysis; Dimethyl Fumarate; Disease Progression; Economics, Medical; Efficiency; Government; Health Status; Humans; Immunosuppressive Agents; Interferon beta-1a; Interferon-beta; Markov Chains; Models, Economic; Multiple Sclerosis; Natalizumab; Polyethylene Glycols; Public Health; Sick Leave; Social Work; Sweden; Taxes
