The impact of increasing neurological disability of multiple sclerosis on health utilities: a systematic review of the literature

Figures & data

Figure 1. Flowchart of study identification and selection.

Table 1. Summary of included study characteristics.

Study	Country	Sample size	Disease type	EDSS score	% on DMDs	Method used	Mean health utilities
Kobelt et al 2006^28	Austria	1,019 MS patients	35.6% of patients were RRMS, 55.1% progressive MS, 7.5% unknown, and 1.9% no answer	Mean EDSS score: 4.4 (40.6% of patients were EDSS 0–3, 35.6% EDSS 4–6.5, 22.2% EDSS 7–9.5)	39.8	EQ-5D	0.55
Kobelt et al 2006^29	Belgium	799 MS patients	38.2% of patients were RRMS, 45.7% progressive MS, 13.6% unknown, 2.5% no answer	Mean EDSS score: 3.9 (45.5% of patients were EDSS 0–3, 33.2% EDSS 4–6.5, 19.7% EDSS 7–9.5)	49.7	EQ-5D	0.7 for patients between 18–30 years of age 0.4 for patients between 50–60 years of age 0.25 for patients older than 70 years of age
Jones et al 2008^22	Canada	302 MS patients	Not reported	Not reported	Not reported	HUI3	0.57 (95% CI: 0.52–0.63)
Fisk et al 2005^23	Canada	187 MS patients	40% of patients were RRMS, 29% PPMS, 24% SPMS, 7% PRMS	Median EDSS score: 6 (22% of patients were EDSS 0–2.5, 23% EDSS 3–5.5, 47% EDSS 6–8, 8% EDSS 8.5–9.5)	Not reported	SF-6DHUI3EQ-5D	SF-6D: range from 0.8 to 0.5 (Estimated from graph) HUI Mark 3: range from 0.8 to 0.05 (Estimated from graph) EQ-5D: range from 0.7 to 0.05 (Estimated from graph)
Grima et al 2000^21	Canada	153 patients in remission and 42 patients experiencing a relapse.	All patients had a history of RRMS (also included were patients who had a history of RRMS but had entered a SPMS).	37 patients at EDSS 1, 41 patients at EDSS 2, 33 patients at EDSS 3, 16 patients at EDSS 4, 7 patients at EDSS 5, 19 patients at EDSS 6.	Not reported	HUI2	Range from 0.83 to 0.59 (based on disease severity)
Kobelt et al 2001^24	Germany	737 MS patients	17.8% were benign, 23.2% RRMS, 23.7% SPMS, 11.5% relapsing-progressive, 20.2% PPMS	Mean EDSS: 4.4 (43.6% of patients were ≤ EDSS 3, 10.0% EDSS 3.5–4.0, 7.5% EDSS 4.5–5.0, 10.0% EDSS 5.5–6.0, 10.5% EDSS 6.5, 16.0% EDSS 7.0, 2.4% EDSS ≥7.5)	43.1	EQ-5D	0.552
Kobelt et al 2006^25	Germany	2,793 MS patients	39.7% were RRMS, 47.4% progressive MS, 8.8% unknown, 4% no answer	Mean EDSS: 3.8 (47.4% of patients were EDSS 0–3, 35.5% EDSS 4–6.5, 12% EDSS 7–9.5)	50.3	EQ-5D	0.62
Kobelt et al 2006^30	Italy	921 MS patients	35.4% were RRMS, 50.7% progressive MS, 11% unknown, 2.9% no answer	Mean EDSS: 4.6 (31.3% of patients were EDSS 0–3, 47.2% EDSS 4–6.5, 19.6% EDSS 7–9.5)	42.6	EQ-5D	0.53
Kobelt et al 2006^31	The Netherlands	1,549 MS patients	28.9% were RRMS, 48.6% progressive MS, 20.5% unknown, 2% no answer	Mean EDSS: 3.9 (47.9% of patients were EDSS 0–3, 39.6% EDSS 4–6.5, 11.2% EDSS 7–9.5)	35.5	EQ-5D	0.61
Kobelt et al 2006^32	Spain	1,848 MS patients	37.3% were RRMS, 45.5% progressive MS, 12.3% unknown, 5% no answer	Mean EDSS: 4.5 (36.1% of patients were EDSS 0–3, 44.8% EDSS 4–6.5, 17.7% EDSS 7–9)	52.4	EQ-5D	0.554
Berg et al 2006^26	Sweden	1,339 MS patients	21.4% were RRMS, 67.7% progressive MS, 9% unknown, 1.9% no answer	Mean EDSS: 5.1 (29.0% of patients were EDSS 0–3, 45.5% EDSS 4–6.5, 25.2% EDSS 7–9)	42.6	EQ-5D	0.546
Henriksson et al 2001^27	Sweden	413 MS patients	34% were RRMS, 26% PPMS, 37% SPMS, 3% no classification	Mean EDSS: 4.93	42	EQ-5D	Range from 0.17 to 0.68 (based on disease severity)
Kobelt et al 2006^33	Switzerland	1101 MS patients	29.1% were RRMS, 56.5% progressive MS, 9.6% unknown, 4.8% no answer	Mean EDSS: 4.5 (38.3% of patients were EDSS 0–3, 35.8% EDSS 4–6.5, 22.8% EDSS 7–9, 14.3% EDSS 8–9)	37.9	EQ-5D	0.59
Orme et al 2007^17	UK	2,048 MS patients	35.5% were RRMS, 37.2% SPMS, 27.3% PPMS	21.3% of patients were EDSS 0–3, 59.6% EDSS 4–6.5, 19.1% EDSS 7–9.5	Not reported	EQ-5D	0.491
Kobelt et al 2006^18	UK	2,048 patients	35.5% were RRMS and remaining progressive MS	21.3% of patients were EDSS 0–3, 59.6% were EDSS score 4–6.5, and remaining were EDSS 7–9	20.6	EQ-5D	0.51
Parkin et al 2000^19	UK	102 patients	All were RRMS patients	37% of patients were EDSS 0–3, 36% EDSS 4–5. 27% EDSS ≥6	Not reported	EQ-5D	Range from 0.35 to 0.71 (based on disease severity)
Forbes et al 1999^20	UK	84 patients	All were SPMS patients	Not reported	Not reported	EQ-5D	Range from –0.260 to 1.0 (based on postal ambulation scale score)
Prosser et al 2003^34	US	62 RRMS patients and 67 members of the general population	Not reported	Mean EDSS: 2.7	Not reported	Standard gamble questions	Range from 0.70–0.98 (based on disease severity)

EDSS, Expanded Disability Status Scale; DMDs, disease modifying drugs; RRMS, relapsing-remitting MS; SPMS, secondary progressive MS.

Table 2. Health utilities by EDSS scores.

Study	Country	Health utilities by EDSS scores
Kobelt et al^28	Austria	EDSS 0–1: 0.89; EDSS 2: 0.73; EDSS 3: 0.59; EDSS 4: 0.58, ; EDSS 5: 0.54; EDSS 6: 0.54; EDSS 6.5: 0.45; EDSS 7: 0.36; EDSS 8–9: 0.06 (estimated from graph)
Kobelt et al^29	Belgium	EDSS 0–1: 0.85; EDSS 2: 0.65; EDSS 3: 0.49; EDSS 4: 0.56, ; EDSS 5: 0.52; EDSS 6: 0.38; EDSS 6.5: 0.39; EDSS 7: 0.27; EDSS 8–9: 0.06 (estimated from graph)
Fisk et al^23	Canada	Ranged from approximately 0.8 for EDSS 1 to 0.1 for EDSS 9 (estimated from graph)
Grima et al^21	Canada	EDSS 1: 0.83; EDSS 2: 0.84; EDSS 3: 0.71; EDSS 4: 0.71; EDSS 5: 0.62; EDSS 6: 0.59 (estimated from graph)
Kobelt et al^24	Germany	EDSS ≤3.0: 0.757; EDSS 3.5–6.0: 0.547; EDSS ≥6.5: 0.232
Kobelt et al^25	Germany	EDSS 0–1: 0.86; EDSS 2: 0.72; EDSS 3: 0.64; EDSS 4: 0.63; EDSS 5: 0.56 ; EDSS 6: 0.51; EDSS 6.5: 0.45; EDSS 7: 0.37; EDSS 8–9: 0.1 (estimated from graph)
Kobelt, et al^30	Italy	EDSS 0–1: 0.80; EDSS 2: 0.68; EDSS 3: 0.62; EDSS 4: 0.62; EDSS 5: 0.52 ; EDSS 6: 0.45; EDSS 6.5: 0.44; EDSS 7: 0.37; EDSS 8–9: 0.06 (estimated from graph)
Kobelt et al^31	The Netherlands	EDSS 0–1: 0.85; EDSS 2: 0.7; EDSS 3: 0.64; EDSS 4: 0.65; EDSS 5: 0.59 ; EDSS 6: 0.5; EDSS 6.5: 0.48; EDSS 7: 0.28; EDSS 8–9: 0.05 (estimated from graph)
Kobelt et al^32	Spain	EDSS 0–1: 0.87; EDSS 2: 0.72; EDSS 3: 0.60; EDSS 4: 0.61; EDSS 5: 0.55; EDSS 6: 0.49; EDSS 6.5: 0.44; EDSS 7: 0.45; EDSS 8–9: 0.08 (estimated from graph)
Berg et al^26	Sweden	EDSS 0–1: 0.83; EDSS 2: 0.70; EDSS 3: 0.65; EDSS 4: 0.61; EDSS 5: 0.58; EDSS 6: 0.57; EDSS 6.5: 0.46; EDSS 7: 0.38; EDSS: 8–9: 0.05 (estimated from graph)
Henriksson et al^27	Sweden	EDSS < 3: 0.68; EDSS 3.5–6: 0.52; EDSS ≥6.5: 0.17
Kobelt et al^33	Switzerland	EDSS 0–1: 0.89; EDSS 2: 0.78 ; EDSS 3: 0.63; EDSS 4: 0.61; EDSS 5: 0.57; EDSS 6: 0.58; EDSS 6.5: 0.54; EDSS 7: 0.43; EDSS 8–9: 0.1 (estimated from graph)
Orme et al^17	UK	EDSS 0: 0.88; EDSS 1: 0.80; EDSS 2: 0.71; EDSS 3: 0.58; EDSS 4: 0.62; EDSS 5: 0.52; EDSS 6: 0.46; EDSS 6.5: 0.47; EDSS 7: 0.30; EDSS 8: –0.04; EDSS 9: –0.19 (estimated from graph)
Kobelt et al^18	UK	EDSS 0: 0.92; EDSS 1: 0.84; EDSS 2: 0.73; EDSS 3: 0.58 ; EDSS 4: 0.63 ; EDSS 5: 0.52; EDSS 6: 0.47; EDSS 6.5: 0.48; EDSS 7: 0.32; EDSS 8: –0.03; EDSS 9: –0.18 (estimated from graph)
Parkin et al^19	UK	EDSS 3: 0.71; EDSS 4: 0.66; EDSS 5: 0.52 ; EDSS 6: 0.49; EDSS 7: 0.35
Prosser et al^34	US	EDSS 2.5: 0.98; EDSS 3.5: 0.95; EDSS 5: 0.97; EDSS 6: 0.86; EDSS 8: 0.70

EDSS, Expanded Disability Status Scale

Figure 2. Health utilities by EDSS scores reported in studies using EQ-5D as the preference elicitation instrument. EDSS, Expanded Disability Status Scale.

Table 3. Health utility loss due to a relapse.

Study	Country	% of Patients experiencing relapses	Utility loss
Kobelt et al^28	Austria	16.8 (prior 3 months)	0.1
Grima et al^21	Canada	28.8 (prior 6 months)	For patients with an EDSS 1–2: 0.1 (estimated from graph)For patients with an EDSS 3–4: 0.05 (estimated from graph)For patients with an EDSS 5–6: 0.05 (estimated from graph)
Kobelt et al^25	Germany	24.4 (prior 3 months)	For patients with an EDSS < 5: 0.09For patients with an EDSS ≥5: 0.05
Kobelt et al^30	Italy	21.5 (prior 3 months)	0.18
Kobelt et al^31	The Netherlands	29.9 (prior 3 months)	For patients with an EDSS < 5: 0.16For patients with an EDSS ≥5: 0.13
Kobelt et al^32	Spain	22.6 (prior 3 months)	0.1
Berg et al^26	Sweden	18 (prior 3 months)	For patients with an EDSS < 5: 0.088For patients with an EDSS ≥5: 0.029
Henriksson et al^27	Sweden	Not reported	0.0635
Kobelt et al^33	Switzerland	16.3 (prior 3 months)	0.8
Kobelt et al^18	UK	28.9 (prior 3 months)	0.8
Orme et al^17	UK	28.9 (prior 3 months)	0.071
Parkin et al^19	UK	39 (not specified)	0.468

EDSS, Expanded Disability Status Scale.

Table

Inclusion criteria	Exclusion criteria
• January 1, 1993 to July 25, 2009• RRMS, SPMS, other forms of MS, or at risk of developing clinically definite MS• Articles in English• Utility studies: ○ Reported utilities for the various health states associated with MS	• Published before 1993• Letters to the editor• No abstract provided• Primary patient population of PPMS

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