Health-related outcomes, health care resource utilization, and costs of multiple sclerosis in Japan compared with US and five EU countries

Figures & data

Table 1 Comparisons of demographics and health characteristics between patients with MS and control group

Parameters		Bivariate comparisons – unweighted			Bivariate comparisons – weighted
		Diagnosed MS (n=85)	Control (n=145,674)	P-value	Diagnosed MS (n=85)	Control (n=80)	P-value
Age (years), mean±SD		47.2±14.1	47.6±15.4	0.831	47.2±1.53	48.2±0.2	<0.001
Sex, n (%)	Female	52 (61.2)	70,862 (48.6)	0.021	52 (61.2)	48 (60.4)	0.884
Currently employed, n (%)	No	47 (55.3)	57,973 (39.8)	0.004	47 (55.3)	44 (55.3)	0.999
	Yes	38 (44.7)	69,291 (47.6)		38 (44.7)	36 (44.7)
University education, n (%)	Less than University education	47 (55.3)	76,383 (52.4)	0.598	47 (55.3)	47 (58.9)	0.506
	University education or higher	38 (44.7)	69,291 (47.6)		38 (44.7)	33 (41.1)
Annual household income, n (%)	<¥3 million	27 (31.8)	26,009 (17.9)	0.003	27 (31.8)	25 (30.8)	0.955
	¥3 million to <¥5 million	17 (20.0)	37,278 (25.6)		17 (20.0)	17 (20.7)
	¥5 million to <¥8 million	20 (23.5)	36,695 (25.2)		20 (23.5)	17 (20.7)
	≥¥8 million	9 (10.6)	30,527 (21.0)		9 (10.6)	10 (12.2)
	Decline to answer	12 (14.1)	15,165 (10.4)		12 (14.1)	13 (15.7)
Type of insurance, n (%)	National Health Insurance	46 (54.1)	65,366 (44.9)	0.064	46 (54.1)	42 (51.9)	0.995
	Social insurance	31 (36.5)	72,131 (49.5)		31 (36.5)	30 (38.0)
	Late-stage elderly insurance	1 (1.2)	1,008 (0.7)		1 (1.2)	1 (1.0)
	Others	4 (4.7)	2,609 (1.8)		4 (4.7)	4 (5.0)
	None of the above	3 (3.5)	4,560 (3.1)		3 (3.5)	3 (4.1)
BMI category, n (%)	Underweight	15 (17.6)	15,494 (10.6)	0.011	15 (17.6)	13 (16.6)	0.999
	Acceptable risk	50 (58.8)	73,667 (50.6)		50 (58.8)	48 (59.8)
	Increased risk	10 (11.8)	40,387 (27.7)		10 (11.8)	9 (11.6)
	High risk	7 (8.2)	10,237 (7.0)		7 (8.2)	7 (8.2)
	Decline to provide weight	3 (3.5)	5,889 (4.0)		3 (3.5)	3 (3.8)
Alcohol use, n (%)	Do not drink	39 (45.9)	42,136 (28.9)	<0.001	39 (45.9)	38 (47.0)	0.832
	Drink alcohol	46 (54.1)	103,538 (71.1)		46 (54.1)	42 (53.0)
Smoking behavior, n (%)	Never smoker	41 (48.2)	79,343 (54.5)	0.107	41 (48.2)	41 (51.4)	0.665
	Former smoker	18 (21.2)	35,422 (24.3)		18 (21.2)	18 (22.4)
	Current smoker	26 (30.6)	30,909 (21.2)		26 (30.6)	21 (26.2)
Exercise behavior, n (%)	Do not exercise	55 (64.7)	81,349 (55.8)	0.100	55 (64.7)	54 (67.0)	0.656
	Regularly exercise	30 (35.3)	64,325 (44.2)		30 (35.3)	26 (33.0)
CCI (mean±SD)		1.3±4.4	0.14±0.48	<0.001	1.3±0.5	0.45±0.07	<0.001

Note: Cost conversion: ¥3 million=US$29,553, ¥5 million=US$49,254, ¥8 million=US$78,807 as per conversion rates on July 1, 2014.

Abbreviations: BMI, body mass index; CCI, Charlson comorbidity index; MS, multiple sclerosis.

Figure 1 Flow diagram of the study respondents.

Abbreviations: CCI, Charlson comorbidity index; MS, multiple sclerosis; NHWS, National Health and Wellness Survey.

Table 2 Effect of MS on health status, work productivity loss, activity impairment, health care resource utilization, and costs

Dependent variable	Diagnosed MS (n=85)	Control (n=80)	Total (n=165)	P-value
MCS, mean±SD	39.8±1.3	45.8±0.1	42.7±0.7	<0.001
PCS, mean±SD	40.9±1.1	50.9±0.1	45.7±0.6	<0.001
Health state utility score, mean±SD	0.62±0.015	0.74±0.001	0.68±0.008	<0.001
Absenteeism, mean±SD (n)	16.9%±3.9% (37)	4.6%±0.5% (34)	11.0%±2.1% (71)	<0.001
Presenteeism, mean±SD (n)	38.9%±4.1% (37)	21.6%±0.7% (34)	30.6%±2.2% (71)	<0.001
Overall work impairment, mean±SD (n)	48.9%±4.4% (37)	23.9%±0.8% (34)	37.0%±2.5% (71)	<0.001
Activity impairment, mean±SD	47.3%±2.7%	25.1%±0.3%	36.6%±1.5%	<0.001
HCP visits in past 6 months, mean±SD	16.8±3.2	6.0±0.2	11.5±1.7	<0.001
Hospitalizations in the past 6 months, mean±SD	3.9±0.9	1.0±0.1	2.5±0.5	<0.001
ER visits in the past 6 months, mean±SD	0.75±0.39	0.15±0.02	0.46±0.2	<0.001
APP indirect costs ($), mean±SD (n)	20,835±1,930 (37)	10,833±245 (34)	16,079±1,084 (71)	<0.001
APP direct costs ($), mean±SD	46,925±10,139	11,611±1,257	29,809±5,312	<0.001
APP HCP costs ($), mean±SD	2,734±515	968±27.3	1,878±272	<0.001
APP hospitalization costs ($), mean±SD	2,364±533	570±67.4	1,495±279	<0.001
APP ER costs ($), mean±SD	462±239	90.8±10.5	282±122	<0.001

Abbreviations: APP, annual per-patient; ER, emergency room; HCP, health care provider; MCS, mental component summary score; MS, multiple sclerosis; PCS, physical component summary score.

Table 3 Effect of MS on health status, work productivity loss, activity impairment, health care resource utilization, and costs after adjustment for age and CCI score

Dependent variable	Adjusted mean±SE (95% CI)		P-value
	Diagnosed MS	Control
MCS	40.1±0.04 (40.0–40.2)	45.8±0.04 (45.7–45.9)	<0.001
PCS	41.4±0.03 (41.3–41.5)	51.2±0.03 (51.1–51.2)	<0.001
SF-6D health state utility score	0.63±0.00 (0.62–0.63)	0.74±0.00 (0.74–0.74)	<0.001
Absenteeism	12.0%±0.4% (11.2%–12.7%)	3.7%±0.1% (3.6%–3.8%)	<0.001
Presenteeism	33.8%±0.6% (32.5%–35.0%)	19.8%±0.1% (19.6%–19.9%)	<0.001
Overall work impairment	40.9%±0.7% (39.5%–42.3%)	21.6%±0.1% (21.5%–21.8%)	<0.001
Activity impairment	43.6%±0.5% (42.7%–44.8%)	24.0%±0.1% (23.9%–24.2%)	<0.001
ER visits in the past 6 months	0.03±0.01 (0.01–0.07)	0.10±0.00 (0.09–0.10)	0.009
Hospitalizations in the past 6 months	2.7±0.17 (2.4–3.1)	0.69±0.02 (0.66–0.72)	<0.001
HCP visits in the past 6 months	8.0±0.4 (7.3–8.7)	4.7±0.02 (4.7–4.8)	<0.001
APP indirect costs ($)	20,102±96.6 (19,914–20,293)	10,603±51.5 (10,502–10,704)	<0.001
APP direct costs ($)	36,162±646 (3,493–37,451)	9,714±185 (9,357–10,084)	<0.001
APP hospitalization costs ($)	1,646±111 (1,440–1,880)	415±9.96 (396–435)	<0.001
APP ER costs ($)	16.8±5.56 (8.80–32.1)	59.0±1.08 (56.9–61.2)	<0.001
APP HCP costs ($)	1,297±46.9 (1,209–1,393)	768±3.08 (762–774)	<0.001

Abbreviations: APP, annual per-patient; CCI, Charlson comorbidity index; ER, emergency room; HCP, health care provider; MCS, mental component summary score; MS, multiple sclerosis; PCS, physical component summary score; SE, standard error; SF-6D, short form-6 dimensions.

Table 4 Independent sample comparisons for demographics and health characteristics among 5EU, Japan, and US patients with MS

Parameters		Bivariate comparisons – unweighted				Bivariate comparisons – weighted
		5EU	Japan	US	P-value	5EU	Japan	US	P-value
n		823	85	2,364		62	85	67
Age (years), mean±SD		47.5±12.3	47.2±14.1	49.7±12.3	<0.001	46.2±1.2	47.2±1.5	46.2±0.6	0.088
Sex, n (%)	Female	542 (65.9)	52 (61.2)	1,603 (67.8)	0.292	37 (59.0)	52 (61.2)	39 (58.4)	0.876
Currently employed, n (%)	No	458 (55.7)	47 (55.3)	1,490 (63.0)	<0.001	33 (52.8)	47 (55.3)	37 (55.8)	0.871
	Yes	365 (44.3)	38 (44.7)	874 (37.0)		29 (47.2)	38 (44.7)	30 (44.2)
University education, n (%)	Less than University education	611 (74.2)	47 (55.3)	1,481 (62.6)	<0.001	37 (60.1)	47 (55.3)	37 (55.4)	0.663
	University education or higher	212 (25.8)	38 (44.7)	883 (37.4)	25 (39.9)	38 (44.7)	30 (44.6)
Annual household income, n (%)	Median income or less	324 (39.4)	44 (51.8)	1,227 (51.9)	<0.001	33 (52.5)	44 (51.8)	36 (54.3)	0.960
	More than the median income	387 (47.0)	29 (34.1)	999 (42.3)		21 (34.3)	29 (34.1)	23 (34.5)
	Declined to answer	112 (13.6)	12 (14.1)	138 (5.8)		8 (13.2)	12 (14.1)	8 (11.2)
BMI category, n (%)	Underweight	22 (2.7)	15 (17.6)	90 (3.8)	<0.001	8 (12.8)	15 (17.6)	10 (15.5)	0.949
	Acceptable risk	386 (46.9)	50 (58.8)	775 (32.8)		38 (60.4)	50 (58.8)	38 (57.0)
	Increased risk	246 (29.9)	10 (11.8)	687 (29.1)		9 (14.6)	10 (11.8)	9 (12.8)
	High risk	147 (17.9)	7 (8.2)	765 (32.4)		6 (9.1)	7 (8.2)	8 (11.2)
	Declined to provide weight	22 (2.7)	3 (3.5)	47 (2.0)		2 (3.0)	3 (3.5)	2 (3.5)
Alcohol use, n (%)	Do not drink	217 (26.4)	39 (45.9)	967 (40.9)	<0.001	26 (41.1)	39 (45.9)	30 (44.7)	0.706
	Drink alcohol	606 (73.6)	46 (54.1)	1,397 (59.1)		37 (58.9)	46 (54.1)	37 (55.3)
Smoking behavior, n (%)	Never smoker	263 (32.0)	41 (48.2)	1,016 (43.0)	<0.001	27 (43.7)	41 (48.2)	31 (46.2)	0.949
	Former smoker	297 (36.1)	18 (21.2)	746 (31.6)		14 (23.3)	18 (21.2)	15 (23.0)
	Current smoker	263 (32.0)	26 (30.6)	601 (25.4)		21 (33.1)	26 (30.6)	21 (30.8)
Exercise behavior, n (%)	Do not exercise	416 (50.5)	55 (64.7)	1,179 (49.9)	0.027	39 (62.7)	55 (64.7)	43 (63.6)	0.933
	Regularly exercise	407 (49.5)	30 (35.3)	1,185 (50.1)		23 (37.3)	30 (35.3)	24 (36.4)
CCI (mean±SD)		0.45±1.6	1.3±4.4	0.55±1.5	<0.001	0.74±0.18	1.3±0.47	0.81±0.14	<0.001

Abbreviations: 5EU, five European Union; BMI, body mass index; CCI, Charlson comorbidity index; MS, multiple sclerosis.

Table 5 Weighted independent sample comparisons for health status among 5EU, Japan, and US patients with MS

Dependent variable	Geography				P-value
	5EU (n=62)	Japan (n=85)	US (n=67)	Total (n=214)
MCS (mean±SD)	41.7±1.0	39.8±1.3	44.7±0.6	41.9±0.6	<0.001
PCS (mean±SD)	37.0±0.8	40.9±1.1	36.9±0.5	38.5±0.5	<0.001
SF-6D health state utility (mean±SD)	0.61±0.01	0.62±0.02	0.62±0.01	0.62±0.01	0.018

Abbreviations: 5EU, five European Union; MCS, mental component summary score; MS, multiple sclerosis; PCS, physical component summary score; SF-6D, short form-6 dimensions.

Table 6 Adjusted means from multivariable analysis of health status in Japan vs US and 5EU as function of MS, controlling for CCI scores

Dependent variable	Group	Adjusted mean±SE (95% CI)	P-value
MCS	US	44.8±0.4 (44.1-45.5)	<0.001
	5EU	41.8±0.4 (41.1-42.5)	<0.001
	Japan	40.1±0.3 (39.5-40.7)	–
PCS	US	36.9±0.3 (36.3-37.6)	<0.001
	5EU	37.0±0.3 (36.3-37.7)	<0.001
	Japan	41.1±0.3 (40.5-41.7)	–
SF-6D health state utility	US	0.62±0.004 (0.62-0.63)	0.979
	5EU	0.61±0.004 (0.60-0.62)	0.006
	Japan	0.62±0.004 (0.62-0.63)	–

Abbreviations: 5EU, five European Union countries; CCI, Charlson comorbidity index; MCS, mental component summary score; MS, multiple sclerosis; PCS, physical component summary score; SE, standard error; SF-6D, short form-6 dimensions.