The long-term costs for treating Multiple Sclerosis in a 16-year retrospective cohort study in Brazil

Isabela Maia Diniz, Augusto Afonso Guerra Júnior, Livia Lovato Pires de Lemos, Kathiaja M Souza, Brian Godman, Marion Bennie, Björn Wettermark, Francisco de Assis Acurcio, Juliana Alvares, Eli Iola Gurgel Andrade, Mariangela Leal Cherchiglia, Vânia Eloisa de Araújo

Research output: Contribution to journalArticle

Abstract

Background: Multiple Sclerosis (MS) is a disease that appreciably impacts on the quality of life of patients and is associated with high expenditure. MS is a chronic multifactorial disease, characterized by inflammation, demyelination and axonal loss. The Brazilian public health system provides pharmacological treatment as well as hospital and outpatient care for patients with relapsing-remitting and secondary progressive multiple sclerosis. However, we are not aware of any previous publications assessing total direct medical costs in patients with a long follow-up within the Brazilian healthcare system. Consequently, the objective is to analyze public spending on patients with MS to guide stakeholders in future investment and disinvestment decisions. Methods and Findings: We retrospectively analyzed public Brazilian spending on patients with MS between 2000 and 2015 using the patient-centered registry of all patients in the public health system (SUS) obtained through deterministic-probabilistic record linkage of the Outpatient Information System, Hospital Information System and Mortality Information Systems in Brazil. Descriptive data analysis and a multiple linear regression model was performed to evaluate the associations between the mean annual cost per patient and the clinical and demographic variables. The suitability of the model was verified from a residue analysis and the level of significance adopted was 5%. Results: 28,401 patients were identified and subsequently 23,082 patients were analyzed. The majority of the patients were female (73.3%), lived in the southeast region (58.9%), had a mean age of 36.8 (± 12.2) years and started treatment using one of the interferons beta (78.9%). The total direct medical cost spending in the sixteen years of the follow-up was US $ 2,308,393,465.60, and the mean annual expenditure per patient was US $ 13,544.40 (± 4,607.05). In the best fit model (p <0.001), approximately 40% of the variability of the mean annual cost per patient was explained by the region of residence; medication used (intention to treat); if the patient was a non-exclusive user of medicines, i.e., used SUS for other procedures other than high-cost medicines; year of treatment start; and presence of events (death; Relapse; change of treatment and/or comorbidity). Conclusions: In the public health system of Brazil, disease modifying therapies currently represent almost all of the total direct costs of multiple sclerosis treatment. Around the world, new and emerging health technologies to treat of MS impose a challenge to health budgets, highlighting the need for cost-effectiveness studies comparing these technologies to those already available. Our regression model may help in this process, and calls attention to the need to access the real world performance of new therapies available in SUS, with the potential for disinvestment and/ or price reductions if needed.
LanguageEnglish
Article number0199446
Number of pages19
JournalPLoS ONE
DOIs
Publication statusPublished - 21 Jun 2018

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sclerosis
cohort studies
Multiple Sclerosis
Brazil
Cohort Studies
Retrospective Studies
Costs and Cost Analysis
Public health
Costs
Information systems
Medicine
Health
information systems
Interferon-beta
Cost effectiveness
public health
Public Health
Linear regression
Health Expenditures
Information Systems

Keywords

  • multiple sclerosis
  • Brazillian public health
  • Brazilian healthcare

Cite this

Diniz, I. M., Guerra Júnior, A. A., Lovato Pires de Lemos, L., Souza, K. M., Godman, B., Bennie, M., ... de Araújo, V. E. (2018). The long-term costs for treating Multiple Sclerosis in a 16-year retrospective cohort study in Brazil. PLoS ONE, [0199446]. https://doi.org/10.1371/journal.pone.0199446
Diniz, Isabela Maia ; Guerra Júnior, Augusto Afonso ; Lovato Pires de Lemos, Livia ; Souza, Kathiaja M ; Godman, Brian ; Bennie, Marion ; Wettermark, Björn ; de Assis Acurcio, Francisco ; Alvares, Juliana ; Gurgel Andrade, Eli Iola ; Cherchiglia, Mariangela Leal ; de Araújo, Vânia Eloisa. / The long-term costs for treating Multiple Sclerosis in a 16-year retrospective cohort study in Brazil. In: PLoS ONE. 2018.
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Diniz, IM, Guerra Júnior, AA, Lovato Pires de Lemos, L, Souza, KM, Godman, B, Bennie, M, Wettermark, B, de Assis Acurcio, F, Alvares, J, Gurgel Andrade, EI, Cherchiglia, ML & de Araújo, VE 2018, 'The long-term costs for treating Multiple Sclerosis in a 16-year retrospective cohort study in Brazil' PLoS ONE. https://doi.org/10.1371/journal.pone.0199446

The long-term costs for treating Multiple Sclerosis in a 16-year retrospective cohort study in Brazil. / Diniz, Isabela Maia; Guerra Júnior, Augusto Afonso; Lovato Pires de Lemos, Livia; Souza, Kathiaja M; Godman, Brian; Bennie, Marion; Wettermark, Björn ; de Assis Acurcio, Francisco; Alvares, Juliana; Gurgel Andrade, Eli Iola; Cherchiglia, Mariangela Leal; de Araújo, Vânia Eloisa.

In: PLoS ONE, 21.06.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The long-term costs for treating Multiple Sclerosis in a 16-year retrospective cohort study in Brazil

AU - Diniz, Isabela Maia

AU - Guerra Júnior, Augusto Afonso

AU - Lovato Pires de Lemos, Livia

AU - Souza, Kathiaja M

AU - Godman, Brian

AU - Bennie, Marion

AU - Wettermark, Björn

AU - de Assis Acurcio, Francisco

AU - Alvares, Juliana

AU - Gurgel Andrade, Eli Iola

AU - Cherchiglia, Mariangela Leal

AU - de Araújo, Vânia Eloisa

PY - 2018/6/21

Y1 - 2018/6/21

N2 - Background: Multiple Sclerosis (MS) is a disease that appreciably impacts on the quality of life of patients and is associated with high expenditure. MS is a chronic multifactorial disease, characterized by inflammation, demyelination and axonal loss. The Brazilian public health system provides pharmacological treatment as well as hospital and outpatient care for patients with relapsing-remitting and secondary progressive multiple sclerosis. However, we are not aware of any previous publications assessing total direct medical costs in patients with a long follow-up within the Brazilian healthcare system. Consequently, the objective is to analyze public spending on patients with MS to guide stakeholders in future investment and disinvestment decisions. Methods and Findings: We retrospectively analyzed public Brazilian spending on patients with MS between 2000 and 2015 using the patient-centered registry of all patients in the public health system (SUS) obtained through deterministic-probabilistic record linkage of the Outpatient Information System, Hospital Information System and Mortality Information Systems in Brazil. Descriptive data analysis and a multiple linear regression model was performed to evaluate the associations between the mean annual cost per patient and the clinical and demographic variables. The suitability of the model was verified from a residue analysis and the level of significance adopted was 5%. Results: 28,401 patients were identified and subsequently 23,082 patients were analyzed. The majority of the patients were female (73.3%), lived in the southeast region (58.9%), had a mean age of 36.8 (± 12.2) years and started treatment using one of the interferons beta (78.9%). The total direct medical cost spending in the sixteen years of the follow-up was US $ 2,308,393,465.60, and the mean annual expenditure per patient was US $ 13,544.40 (± 4,607.05). In the best fit model (p <0.001), approximately 40% of the variability of the mean annual cost per patient was explained by the region of residence; medication used (intention to treat); if the patient was a non-exclusive user of medicines, i.e., used SUS for other procedures other than high-cost medicines; year of treatment start; and presence of events (death; Relapse; change of treatment and/or comorbidity). Conclusions: In the public health system of Brazil, disease modifying therapies currently represent almost all of the total direct costs of multiple sclerosis treatment. Around the world, new and emerging health technologies to treat of MS impose a challenge to health budgets, highlighting the need for cost-effectiveness studies comparing these technologies to those already available. Our regression model may help in this process, and calls attention to the need to access the real world performance of new therapies available in SUS, with the potential for disinvestment and/ or price reductions if needed.

AB - Background: Multiple Sclerosis (MS) is a disease that appreciably impacts on the quality of life of patients and is associated with high expenditure. MS is a chronic multifactorial disease, characterized by inflammation, demyelination and axonal loss. The Brazilian public health system provides pharmacological treatment as well as hospital and outpatient care for patients with relapsing-remitting and secondary progressive multiple sclerosis. However, we are not aware of any previous publications assessing total direct medical costs in patients with a long follow-up within the Brazilian healthcare system. Consequently, the objective is to analyze public spending on patients with MS to guide stakeholders in future investment and disinvestment decisions. Methods and Findings: We retrospectively analyzed public Brazilian spending on patients with MS between 2000 and 2015 using the patient-centered registry of all patients in the public health system (SUS) obtained through deterministic-probabilistic record linkage of the Outpatient Information System, Hospital Information System and Mortality Information Systems in Brazil. Descriptive data analysis and a multiple linear regression model was performed to evaluate the associations between the mean annual cost per patient and the clinical and demographic variables. The suitability of the model was verified from a residue analysis and the level of significance adopted was 5%. Results: 28,401 patients were identified and subsequently 23,082 patients were analyzed. The majority of the patients were female (73.3%), lived in the southeast region (58.9%), had a mean age of 36.8 (± 12.2) years and started treatment using one of the interferons beta (78.9%). The total direct medical cost spending in the sixteen years of the follow-up was US $ 2,308,393,465.60, and the mean annual expenditure per patient was US $ 13,544.40 (± 4,607.05). In the best fit model (p <0.001), approximately 40% of the variability of the mean annual cost per patient was explained by the region of residence; medication used (intention to treat); if the patient was a non-exclusive user of medicines, i.e., used SUS for other procedures other than high-cost medicines; year of treatment start; and presence of events (death; Relapse; change of treatment and/or comorbidity). Conclusions: In the public health system of Brazil, disease modifying therapies currently represent almost all of the total direct costs of multiple sclerosis treatment. Around the world, new and emerging health technologies to treat of MS impose a challenge to health budgets, highlighting the need for cost-effectiveness studies comparing these technologies to those already available. Our regression model may help in this process, and calls attention to the need to access the real world performance of new therapies available in SUS, with the potential for disinvestment and/ or price reductions if needed.

KW - multiple sclerosis

KW - Brazillian public health

KW - Brazilian healthcare

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DO - 10.1371/journal.pone.0199446

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JF - PLOS One

SN - 1932-6203

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