Secondary progressive multiple sclerosis: a systematic review of costs and health state utilities

Abstract

Objective: To identify evidence in the literature presenting the economic and humanistic (based on health state utility values [HSUVs]) burden of multiple sclerosis (MS) and report the incremental burden of secondary progressive MS (SPMS) compared with relapsing–remitting MS (RRMS).

Methods: Electronic databases (Embase, MEDLINE, MEDLINE In-Process, Cochrane Library) and other relevant repositories were systematically searched from the date of inception until November 2019 for evidence on the economic burden of MS, or HSUVs in patients with MS. Data were extracted from studies investigating cost data or HSUVs for patients with SPMS compared with RRMS.

Results: In total, 25 studies were identified that reported data on the economic and HSUV burden of SPMS versus RRMS: 18 studies reported cost data and nine presented HSUVs. Overall, costs associated with SPMS were consistently higher than those for RRMS. Major cost drivers appeared to shift following transition from RRMS to SPMS, with higher direct medical costs associated with RRMS than with SPMS, while the opposite was true for direct non-medical costs and indirect costs. In all studies presenting HSUVs specifically in patients with SPMS, the disease burden was greater (indicated by lower HSUV scores or a negative regression coefficient vs RRMS) for patients with SPMS than for those with RRMS. Fatigue and psychological stress (including depression) were identified as key drivers of this reduced health-related quality of life (HRQoL).

Conclusions: Our findings indicate that SPMS is associated with higher costs and more substantial HRQoL decrements than RRMS. These results highlight the substantial unmet need for effective treatments that can slow disease progression in patients with SPMS, which, in turn, would reduce the rate of HRQoL deterioration and increasing healthcare costs.

Keywords:

• Secondary progressive multiple sclerosis
• cost of illness
• economic value of life
• systematic review

Transparency

Declaration of funding

This study was sponsored by Novartis Pharma AG. Oxford PharmaGenesis received funding from Novartis Pharma AG.

Declaration of financial/other relationships

In the last 3 years, JC has received support from the Efficacy and Evaluation (EME) Programme, a Medical Research Council (MRC) and National Institute for Health Research (NIHR) partnership and the Health Technology Assessment (HTA) Programme (NIHR), the UK MS Society, the US National MS Society and the Rosetrees Trust. He is supported in part by the NIHR, University College London Hospitals, Biomedical Research Centre, London, UK. He has been a local principal investigator for a trial in MS funded by the Canadian MS society. He has been a local principal investigator for commercial trials funded by: Actelion, Biogen, Novartis, and Roche; has received an investigator grant from Novartis; and has taken part in advisory boards/consultancy for Azadyne, Biogen, Celgene, Janssen, MedDay, Merck, Novartis and Roche. NA is a full-time employee of Novartis Pharma AG, and NM was an employee at the time of this study. VK is an employee of Novartis Corporation (Malaysia) Sdn. Bhd. HS and JF are full-time employees of Oxford PharmaGenesis Ltd. Peer reviewers on this manuscript have received an honorarium from CMRO for their review work but have no other relevant financial relationships to disclose.

Author contributions

VK conducted the original systematic review searches, and VK, HS and JF conducted the updated systematic review searches. HS and JF drafted the manuscript and all authors critically reviewed the manuscript. All authors gave final approval of the version to be published and all authors agree to be accountable for all aspects of the work.

Acknowledgements

Editorial and medical writing support were provided by PharmaGenesis Oxford Central, Oxford, UK and were funded by Novartis Pharma AG, Basel, Switzerland.

Data availability statement

There is no data set for this review.