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VBCN - May 2015 Volume 2, No 1 - Health Economics
Chase Doyle

Washington, DC—In the year following a relapse, patients with multiple sclerosis remained less productive and their health deteriorated further compared with patients with multiple sclerosis whose disease had not relapsed, according to analyses presented at the 2015 annual meeting of the American Academy of Neurology.

“The work productivity of MS [multiple sclerosis] patients declined following a relapse,” reported the lead author of the study, Stefan Vormfelde, MD, PhD, Medical Advisor at Novartis Pharma GmbH in Nürnberg, Germany. “One may bear this in mind when monitoring the disease status in relapsing-remitting MS patients. Escalating therapy early, however, may reduce such costs.”

Relapsing-remitting multiple sclerosis can be a devastating disease, with a significant impact on a patient’s health-related quality of life, Dr Vormfelde explained.

“The frequency of exacerbations and the natural progression of disability and neurologic compromise that occurs during the disease course results in considerable accumulation of medical costs and economic burden,” he said. “Such problems have led to an ongoing discussion as to whether medical, patient, and healthcare costs caused by relapses warrant early escalation of pharma­co­therapy.”

The PEARL Study

The Prospective Pharmacoeconomic Cohort Evaluation (PEARL) trial is a 2-year, multicenter, noninterventional study involving 1705 patients with relapsing-remitting multiple sclerosis. PEARL has focused on real-world aspects of healthcare for patients with multiple sclerosis, describing the consequences of a multiple sclerosis relapse from an economic perspective by collecting resource utilization data from 163 neurology practices in Germany. To be included in the study, patients with relapsing-remitting multiple sclerosis were required to have been treated with interferon beta (N = 1214) or with glatiramer acetate (N = 491) for at least 30 days.

In the first year of study, 411 patients had relapsed disease at least once; these patients constituted the active group. The remaining 1294 patients who did not experience relapsed disease were the inactive group.

Patterns of Decline


Disability, as measured by the Expanded Disability Status Scale (EDSS), was worse in patients in the active group at baseline and deteriorated further for the duration of the study from a score of 2.5 to 3.0 on the EDSS. EDSS scores for patients in the inactive group deteriorated from a 2.2 to 2.4. The mean annual relapse rate was 1.4 and 0.1 relapses annually during the 2-year period, in the active versus the inactive group, respectively.

As measured by the Clinical Global Impression improvement scale, health worsening peaked in active patients in the first study year and then remained elevated. Patients in the active group switched drug therapies more often than those in the inactive group (30% vs 12%, respectively) and rated their treatment to be less satisfactory than did patients in the inactive group.

Economic Implications


Having established a pattern of declining health status in the active group, Dr Vormfelde next examined the economic repercussions of disease relapse. Data regarding employment status and work productivity; sick leave and absence from work; and hospitalization and rehabilitation were presented in a separate analysis, which continued the depiction of impaired quality of life for patients in the active group.

“Employment declined in the active group from 58% to 53%,” reported Dr Vormfelde, “while it was stable for inactive patients (61%).”

Patients in the active group who were able to maintain employment still noted a significant impairment of their work productivity, tending to be absent from work more often than their inactive counterparts. Multiple sclerosis–related sick leave was frequent among those in the active group; the rate of sick leave in the inactive group, however, was reduced over time. Patients in the active group indicated that they felt continuously impaired, whereas patients in the inactive group recovered over time. Finally, patients in the active group tended to be hospitalized more frequently than were patients in the inactive group.

According to Dr Vormfelde, these discrepancies of health and economic productivity between patients with relapsing and nonrelapsing disease highlight the importance of avoiding relapse in the first place.

“Better relapse prevention by early escalation of therapy may reduce indirect costs related to reduced productivity and employment,” concluded Dr Vormfelde.

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Last modified: June 1, 2015
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