The direct cost of patients with multiple sclerosis: a survey from Italian MS centres

Multiple sclerosis (MS) is a chronic progres- sive disease of the CNS causing disability and neurological symptoms that carry a substantial burden. Previous Italian studies appear outdated, and investigation on the burden of recently marketed drug treatments should provide further economic evidence for policy makers. The objective of the study was to investigate patterns of care, resource con- sumption and direct medical cost of MS, in the perspective of the public health-care provider. Ten MS experts from public centres extracted and reported data of all MS patients seen during 2009, using a detailed questionnaire. The data of 8,326 MS patients were analysed: the course was relapsing-remitting in 5,376 (62%), secondary progressive in 1,798 (23%) and primary progressive in 691 (9%); 461 (6%) had a clinically isolated syndrome. The EDSS score was 0-3.5 in 5,118 (61%) patients, 4-6.5 in 2,408 (29%) and 7-9.5 in 800 (10%). The average cost of diagnosis (N = 694) was 1,236 €/patient with large varia- tions between centres due to the chosen diagnostic setting. The average direct medical cost for biological disease- modifying drugs (bio-DMD) was 10,444 €/patient/year (cost/patient by primary drug: 9,501 € for interferon (IFN)-beta1a-im; 8,553 € for IFN-beta1b; 11,255 € for IFN-beta1a-sc44; 9,883 € for IFN-beta1a-sc22; 8,174 € for glatiramer acetate (GA); 21,817 € for natalizumab) and 3,151 € for non-bio-DMD. The cost of diagnosis is largely influenced by care setting, due to local health-care provi- sion patterns. The annual medical cost/patient is largely driven by the cost of drugs (89.2% of total); GA represents the least expensive bio-DMD in the Italian health-care