Economic burden of amyotrophic lateral sclerosis: A Canadian study of out-of-pocket expenses

Abstract

This study quantifies the ‘out-of-pocket’ expenses incurred by individuals with amyotrophic lateral sclerosis (ALS) and their families, explores cost-driving factors and describes the current state of financial support in a Canadian cohort. We performed structured cost-of-illness interviews with 50 consecutive ALS patients and family members detailing disease-specific factors, direct and indirect costs. Direct costs were divided into ‘out-of-pocket’ and ‘government/non-profit organization (NPO) supported’. Results showed that the average annual direct cost per patient was $32,337, of which $19,574 (61%) was paid for out-of-pocket. The most significant direct cost was disease-related home renovations, which garnered minimal government or NPO support. The costs of mobility aids, medical expenses, and private personal support workers were also substantial. Higher out-of-pocket costs were associated with an ALS Functional Rating Scale gross motor subscore of ≤ 6 (p = 0.03), limb-predominant symptoms (p = 0.04) and > 4 h/week of personal support care (p = 0.005). Annual indirect costs (lost wages) for patients with ALS and family members providing care were $56,821. In conclusion, this study quantified the substantial personal economic impact of ALS as measured by non-reimbursed, out-of-pocket expenses. Mobilization of additional resources for ALS patients and families is required to soften the economic burden of this disabling disease.

Key words::

• Amyotrophic lateral sclerosis
• economics
• direct costs
• indirect costs
• out-of-pocket costs

Acknowledgements

Study design and data acquisition was assisted by Diagnosis, Solutions, & Results Inc. The authors are grateful for the commitment and help of all participants and their families.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Lorne Zinman receives research support from the Canadian Institute of Health Research, National Institute of Health, and ALS Canada.

This study was supported by The ALS Society of Canada.