Abstract
Background
MS relapses are unpredictable and can be concerning to patients and their caregivers.
Objective
To assess the direct and indirect cost burden associated with relapses of different
severities in MS patients and with MS relapse frequency on spouse caregivers.
Methods
Using a U.S. insurance claims and employee disability database (1999–2011), we studied
adult MS patients (ICD-9-CM: 340.x) and their spouse caregivers. A previously published
algorithm to identify relapses was used to stratify: (1) MS patients into cohorts
of no, low/moderate, and high severity relapse based on the most severe relapse within
one year of follow-up (if any); (2) caregivers into cohorts of no, less, and more
frequent relapses based on the overall frequency of relapses of their spouse. Adjusted
cost differences and 95% confidence intervals evaluating the yearly incremental costs
at 12 months of follow-up (MS patients) and overall (caregivers) associated with relapses
are reported.
Results
Among the 9421 MS patients (N: no relapse = 7686; low/moderate severity relapse = 1220; high severity relapse = 515) identified, both relapse cohorts incurred significantly higher annual incremental
direct costs than the no relapse cohort (low/moderate severity = $8269 [6565–10,115]; high severity = $24,180 [20,263–28,482]) and indirect costs (low/moderate severity = $1429 [759–2147]; high severity = $2714 [1468–4035]). More frequent relapses versus no relapse also translated into
a significantly greater cost burden for caregivers (direct + indirect = $1725 [376–2885]) but less frequent relapses did not.
Conclusions
Relapse severity was significantly and increasingly associated with greater direct
and indirect costs in MS patients. More frequent relapses also translated into a significant
cost burden in spouse caregivers.
Keywords
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Article info
Publication history
Published online: May 06, 2013
Accepted:
April 10,
2013
Received in revised form:
April 3,
2013
Received:
November 14,
2012
Identification
Copyright
© 2013 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
