Economic burden of highly active relapsing-remitting multiple sclerosis patients in the French national health insurance database

Figures & data

Table 1. Highly active relapsing-remitting adult incident patients’ characteristics (N = 9,596)

Characteristic	Patients
Age at inclusion,years, mean (SD)	39.9 (10.5)
Sex, no. (%) Male Female	2,529 (26.4%) 7,067 (73.7%)
MS LTD status at inclusion, no. (%)	9,539 (99.4%)
Disability pension at inclusion among patients <60 years old at inclusion (N = 9,238)	1,835 (19.1%)
Disability pension level at inclusion (N = 1,835), no. (%) 1 2 3 (highest level, more disabilities)	580 (31.6%) 1,153 (62.8%) 102 (5.6%)
First change in disability pension level during the study, including absence of pension No change Increase in benefit level (worsening of disability) Decrease in benefit level (improvement in autonomy)	7,249 (78.5%) 1,863 (20.2%) 126 (1.4%)

LTD: long-term disease; MS: multiple sclerosis; SD: standard deviation

Table 2. Healthcare use (all disease and injuries combined) of highly active relapsing-remitting adult incident patients with at least two years of follow-up (N = 8,045)

	Number of patients with at least one item during the study (%)	Mean annual number of items during the study (SD)
Healthcare
Drug
MS-related drug
DMT	3,809 (39.7%)	-
HE DMT	8,012 (83.5%)	-
Hospital care
MS-related hospital care	7,485 (93.0%)	4.4 (4.6)
Outpatient department visit	842 (10.5%)	0.1 (0.8)
Primary and secondary care visits
General practitioner	8,004 (99.5%)	8.2 (5.9)
Dentist	6,381 (79.3%)	2.2 (2.5)
Ophthalmologist	5,827 (72.4%)	0.9 (1.1)
Gynecologist (N = 5,946 women)	3.711 (62.4%)	1.1 (2.0)
Neurologist	3,342 (42.7%)	0.8 (1.4)
Dermatologist	3,420 (42.5%)	0.3 (0.6)
Cardiologist	1,759 (21.9%)	0.2 (0.4)
Gastroenterologist	1,152 (14.3%)	0.1 (0.3)
Psychiatrist	1,047 (13.0%)	0.7 (4.7)
Urologist	632 (7.9%)	0.1 (0.3)
Medicine and rehabilitation physician	422 (5.3%)	0.1 (1.9)
Neurosurgeon (excludes hospital surgeon)	83 (1.0%)	0.0 (0.1)
Other medical professional visit
Nurse (excludes hospital nurse)	6,927 (86.1%)	28.2 (145.2)
Physiotherapist	5,906 (73.4%)	26.0 (37.9)
Orthoptist	1,405 (17.5%)	0.3 (1.9)
Podiatrist	870 (10.8%)	0.1 (0.4)
Speech therapist	682 (8.5%)	1.3 (6.5)
Laboratory test (most common)
Complete blood count	7,917 (98.4%)	4.1 (3.1)
Transaminase	7,750 (96.3%)	3.4 (2.7)
Creatinemia	7,471 (92.9%)	2.0 (2.2)
Imaging procedure (most common)
MRI	7,505 (93.3%)	0.9 (0.7)
Ophthalmological exam	6,191 (77.0%)	0.9 (1.2)
Bladder kidney ultrasound	4,323 (53.7%)	0.3 (0.6)
Electrocardiogram	3,921 (48.7%)	0.3 (0.7)
Medical device	6,997 (87.0%)	-
Transportation	5,452 (67.8%)	-

DMT: Disease-Modifying Treatment; HE DMT: High Efficacy Disease-Modifying Treatment; MRI: magnetic resonance imaging; MS: multiple sclerosis

Table 3. Cost of highly active relapsing-remitting adult incident patients with at least two years of follow-up and usable cost data (N = 7,956)

	During the whole follow-up			During the first year of inclusion
Item	Number of patients with at least one (%)	Annual cost per patient with at least one, mean (SD)	Annual cost per patient, mean (% of overall cost) (€)	Number of patients with at least one (%)	Cost per patient with at least one, mean (SD)	Cost per patient, mean (% of overall cost) (€)
Healthcare expenses
Drug	7,953 (100.0%)	11,932 (8,898)	11,928 (40.0%)	7,925 (99.6%)	11,751 (10,736)	11,705 (36.5%)
Hospital care	7,546 (94.8%)	10,283 (12,244)	9,753 (32.7%)	6,754 (84.9%)	15,124 (16,260)	12,839 (40.0%)
Outpatient department visit or procedure	7,741 (97.3%)	1,118 (1,655)	1,088 (3.6%)	7,450 (93.6%)	1,018 (2,546)	953 (3.0%)
Primary and secondary care visit	7,939 (99.8%)	255 (245)	254 (0.9%)	7,844 (98.6%)	275 (306)	271 (0.8%)
Other medical professional visit	7,785 (97.9%)	931 (2,161)	911 (3.1%)	6,839 (86.0%)	909 (2,026)	781 (2.4%)
Laboratory test	7,886 (99.1%)	157 (129)	156 (0.5%)	7,306 (91.8%)	186 (175)	171 (0.5%)
Imaging procedure	7,880 (99.0%)	251 (224)	249 (0.8%)	7,123 (89.5%)	265 (282)	237 (0.7%)
Other medical procedure	6,852 (86.1%)	99 (124)	85 (0.3%)	4,235 (53.2%)	153 (224)	81 (0.3%)
Medical device	7,596 (95.5%)	734 (1,774)	701 (2.4%)	5,900 (74.2%)	713 (1,770)	529 (1.6%)
Transportation	5,462 (68.7%)	1,279 (2,371)	878 (2.9%)	4,179 (52.5%)	1,654 (2,839)	869 (2.7%)
Other (excludes hospital care)	7,973 (100.2%)	150 (568)	150 (0.5%)	7,768 (97.6%)	154 (771)	150 (0.5%)
Other expenses
Disability pension	3,024 (38.0%)	7,168 (4,841)	2,724 (9.1%)	1,967 (24.7%)	7,662 (5,005)	1,894 (5.9%)
Paid sick leave	3,807 (47.9%)	1,956 (2,339)	936 (3.1%)	2,864 (36.0%)	4,372 (4,679)	1,574 (4.9%)
Total	7,956 (100.0%)	29,813 (13,266)	29,813 (100.0%)	7,956 (100.0%)	32,059 (15,212)	32,059 (100.0%)

For a list of primary and secondary care specialists and other medical professionals included in the study, see Table 2.

Imaging procedure: magnetic resonance imaging (MRI), ophthalmological exam, electrocardiogram, echocardiography, pulmonary radiography, abdominal radiography, skeleton radiography, sinus radiography and panorex, bladder kidney ultrasound, and cardiac scintigraphy.

Figure 1. Mean annual cost per highly active relapsing-remitting adult incident patient with at least two years of follow-up and usable cost data (N = 7,956), in all patients and by inclusion criterion, by large category of items

(a): All patients; (b): Criterion 1 (5,464 patients): At least one reimbursement of HE DMT (natalizumab, fingolimod); (c): Criterion 2 (139 patients): At least two relapses in one year and no previous treatment for MS during the previous two years and an MRI of the central nervous system performed during the three months following the second relapse and a DMT during the six months following the MRI; (d): Criterion 3 (2,345 patients): One relapse in one year despite a DMT, with an MRI of the central nervous system performed during the three months following the relapse and a switch of DMT during the six months following the MRI. Of note, the number of patients followed decreases over time; therefore, results should be interpreted with caution, particularly the eighth year (829 patients).

Figure 2. Mean annual cost per calendar year per highly active relapsing-remitting adult incident patient with at least two years of follow-up and usable cost data (N = 7,956), in all patients and by inclusion criterion, with 95% confidence intervals

Criterion 1 (5,464 patients): At least one reimbursement of HE DMT (natalizumab, fingolimod); Criterion 2 (139 patients): At least two relapses in one year and no previous treatment for MS during the previous two years and an MRI of the central nervous system performed during the three months following the second relapse and a DMT during the six months following the MRI; Criterion 3 (2,345 patients): One relapse in one year despite a DMT, with an MRI of the central nervous system performed during the three months following the relapse and a switch of DMT during the six months following the MRI.Notes: The mean annual cost in each calendar year is lower than the mean cost for the first year after inclusion (presented in Figure 1) because some patients have less than a year of expenditures (i.e. patients included in July only have six months of expenditures). In 2012, there was only one criterion 2 patient; therefore, there is no confidence interval for that year.

Figure 3. Mean annual cost per highly active relapsing-remitting adult incident patient with at least two years of follow-up and usable cost data, in 2010 (N = 1,097) and 2015 (N = 1,258)

Healthcare professionals’ visits: primary and secondary car visits, other medical professional visits, and outpatient departments visits and procedures

Availability of data and material

Data from the National Health data system in France (Système National des Données de Santé, SNDS) are publicly available (https://www.snds.gouv.fr/SNDS/Processus-d-acces-aux-donnees) after acceptance from the French data protection authority (Comité National d’informatique et Liberté, CNIL). The datasets analyzed during the current study are available from co-author FR on reasonable request. All data generated or analyzed during this study are included in this published article.