Factors associated with the healthcare expenditures of patients with multiple sclerosis in urban areas of China estimated by a generalized estimating equation

ABSTRACT

Background: Multiple sclerosis (MS) has a significant healthcare burden. This study examined the medical cost and out-of-pocket (OOP) expenses, and quantified the impact factors contributing to the costs.

Methods: This is a retrospective study in 77 Chinese urban cites from 2013 to 2015. The data included the details of the utilization of medical resources, cost, and reimbursement ratio of all patients with a diagnosis of MS. A generalized estimating equation model was used to estimate the factors influencing the direct medical cost and OOP expenses for in- and outpatients.

Results: A total of 267 patients with MS were identified. The mean cost per in- and outpatient was respectively 16996.2 and 2294.2 renminbi ($2768.12 and $373.65, €2087.16 and €281.73). Approximately 27% of the expenses were paid by the patients OOP. Factors contributing to high cost and high OOP expenses for inpatients were tertiary hospital admission, length of stay and residence in the east regions of China. Females and outpatients with resident insurance paid more OOP.

Conclusion: This study illustrates the medical costs and burden of MS in Chinese patients and provides real-world data on MS that are essential for the improvement of health policies.

KEYWORDS:

• Multiple sclerosis (MS)
• healthcare expenditures
• medical cost
• out-of-pocket (OOP) expenses
• generalized estimating equation (GEE)
• China

Article Highlights

• Multiple sclerosis patients were concentrated in the eastern regions of China, and were mainly treated in tertiary hospitals.

• The mean costs incurred by in- and outpatients were $2768.12 and $373.65, respectively, of which up to 27% were OOP expenses.

• The cost of traditional Chinese medicine was relatively high, and patients did not use the approved disease-modifying drugs.

• The type of medical insurance, the medical institution, and the regions were the main factors affecting the medical cost and OOP expenses.

Acknowledgments

We are grateful for the support of the China Medical Insurance Research Association (CMIRA). We also gratefully acknowledge Prof. Xinping Zhang for her valuable support and helpful suggestions. Finally, would like to acknowledge Dr. Ivan Hajnal for language modification.

Author contributions

Yaling Du was involved in the conception and design, analysis and interpretation of the data, and drafting of the paper and revised it. Rui Min, Xiaoyan Zhang, and Pengqian Fang were involved in the conception and design, and revising the paper. All the authors were involved in the final approval of the version to be published, and all authors agree to be accountable for all aspects of the work.

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

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

Additional information

Funding

This paper was funded by the National Natural Science Foundation of China [number 71333005].