The societal costs of multiple sclerosis in Lebanon: a cross-sectional study

ABSTRACT

Introduction

This study assessed the societal costs of multiple sclerosis (MS) in Lebanon, categorized by disease severity.

Methods

This was a cross-sectional, prevalence-based, bottom-up study using a face-to-face questionnaire. Patients were stratified by disease severity using the expanded disability status scale (EDSS); EDSS scores of 0–3, 4–6.5, and 7–9 indicating respectively mild, moderate, and severe MS. All direct medical, nonmedical, and indirect costs related to reduced productivity were accounted for regardless of who bore them. Costs, collected from various sources, were presented in international US dollars (US$) using the purchasing power parity (PPP) conversion rate.

Results

We included 210 Lebanese patients (mean age: 43.3 years; 65.7% females). The total annual costs per patient were PPP US$ 33,117 for 2021, 12.4 times higher than the nominal GDP per capita. Direct costs represented 52% (US$ 17,185), direct nonmedical costs 8% (US$ 2,722), and indirect costs 40% (US$ 13, 211) of the mean annual costs. The total annual costs per patient increased with disease severity and were PPP US$ 29,979, PPP US$ 36,125, PPP US$ 39,136 for mild, moderate, and severe MS, respectively.

Conclusion

This study reveals the huge economic burden of MS on the Lebanese healthcare system and society.

KEYWORDS:

• cost-of-illness
• economic burden
• healthcare consumption
• Lebanon
• multiple sclerosis
• productivity losses

Article highlights

• Though the economic burden of multiple sclerosis (MS) has been extensively assessed in high-income countries (HICs), such information in low–and middle-income countries (LMICs), such as Lebanon, remains limited.

• In this study we assessed the societal costs (including all direct medical, non-medical, and indirect costs) of MS in Lebanon, categorized by disease severity using the expanded disability status scale (EDSS); where EDSS scores of 0–3, 4–6.5, and 7–9 indicated mild, moderate, and severe MS, respectively.

• This study reveals the huge economic burden of MS on the Lebanese healthcare system and society. We reported high total annual costs per patient; purchasing power parity (PPP) US dollars (US$) 33,117 for 2021, 12.4 times higher than the nominal GDP per capita.

• The total annual costs per patient increased with disease severity and were PPP US$ 29,979, PPP US$ 36,125, PPP US$ 39,136 for mild, moderate, and severe MS, respectively.

• Our results are in line with existing literature in terms of cost drivers, where costs increased with increasing disability, dominated by disease modifying therapies (DMTs) in mild MS and productivity losses in moderate and severe disease.

• The high burden of MS shall draw the public’s attention to the precise economic impact that MS poses on Lebanese society in general, and specifically in light of the prevailing crises that further contributed to the scarcity of health resources.

Acknowledgments

The authors are grateful to Mrs. Lina Abdul Latif-Malaeb, Clinical Research Manager at the

American University of Beirut Medical Center, Nehme and Therese Tohme Multiple Sclerosis Center, for her support in collecting data from MS patients related to health resources consumption. A draft of the work/data was presented as an abstract at the 14th Lowlands Health Economic Study Group (LolaHESG) held in Maastricht, in May 2022.

Declaration of interests

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethical standards

Ethical approval (SBS-2019-0268) was obtained from the American University of Beirut Institutional Review Board.

Author contributions

All authors were involved in the concept and design. Valuation of costs and statistical analysis were performed by J Dahham, M Hiligsmann, and R Rizk. Results were interpreted by J Dahham, M Hiligsmann, I Kremer, S Evers, and R Rizk. J Dahham drafted the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript. All authors agree for the final version to be published and to be accountable for all aspects of the work.

Informed consent

All patients provided written informed consent for the collection of clinical and health economic information.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2023.2184802

Additional information

Funding

This study was funded by (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban (INSPECT-LB). The primary investigator of this research has received funding to cover the expenses of field research that consisted of data collection from Multiple Sclerosis patients from December 2020 to August 2021.