The Economic Burden of Moderate-to-Severe Multiple Sclerosis Relapse in the United States: Findings from a Systematic Literature Review (P3.402)
2017
Objective: To characterize the economic burden of moderate-to-severe multiple sclerosis (MS) relapse in the US via systematic literature review (SLR). Background: Several studies have assessed MS relapse burden. Given known heterogeneity with relapse, we focused on moderate-to-severe relapse burden. Design/Methods: We searched for resource use and cost information in adults with MS experiencing moderate-to-severe relapse. Automated searches (MEDLINE, Embase, The Cochrane Library, Econ Lit, BIOSIS) and manual searches (grey literature) restricted to full-text, English-language material published during 01/2010–10/2015 were performed. Where relapse severity was unspecified and relapse treatment (i.e., services/prescriptions) was not required, studies were excluded. Results: Of 4,263 search results, 24 studies met eligibility criteria (17 database studies, 3 surveys, 4 clinical trials); all studies reported direct costs/resource use, three estimated indirect costs/lost productivity, and one assessed caregiver economic burden. Eleven studies used a claims-based relapse algorithm 1 with a positive predictive value of 67.3% 2 (Ollendorf et al. 2002 1 ; Chastek et al. 2010 2 ), in which relapse treatments, duration, patient functioning and disability are incompletely or not addressed. Studies used varying designs, relapse definitions, durations, and metrics, thereby complicating synthesis and interpretation of results. Notable results [inflated to 2016 3 ] included: 90-day direct costs of high- and moderate-intensity relapse of $12,870 and $1,847 4 [2016: $17,230.56 and $2,472.79], and 1-year adjusted cost difference (combined direct and indirect costs) comparing high and low/moderate severity relapse cohorts with a no-relapse MS cohort of $24,927 and $10,891 5 [2016: $26,690.54 and $11,661.52] (http://www.usinflationcalculator.com/ 3 ; O’Brien et al. 2001 4 , Parise et al. 2013 5 ). The latter 5 estimated spouse caregiver burden by relapse frequency; therefore, patient and caregiver burden could not be easily combined towards quantification of overall burden. Conclusions: Current literature underappreciates the economic burden of moderate-to-severe MS relapse in terms of frequency, duration, and impacts. Exploration into implications for relapse awareness, characterization, and management, including a thorough evaluation of available treatment options, is warranted. Study Supported by: Mallinckrodt Pharmaceuticals Disclosure: Ms. Nazareth has received personal compensation for activities with Mallinckrodt Pharmaceuticals. Dr. Purser has nothing to disclose. Dr. Bhaila has nothing to disclose. Dr. Philbin has received personal compensation for activities with Mallinckrodt Pharmaceuticals as an employee. Dr. Philbin has received research support from Mallinckrodt Pharmaceuticals. Dr. Mladsi has nothing to disclose.
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