Social value of a set of proposals for the ideal approach of multiple sclerosis within the Spanish National Health System: a social return on investment study

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Abstract

Background

Multiple Sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease that in many cases produces disability, having a high impact in patients’ lives, reducing significantly their quality of life. The aim of this study was to agree on a set of proposals to improve the current management of MS within the Spanish National Health System (SNHS) and apply the Social Return on Investment (SROI) method to measure the potential social impact these proposals would create.

Methods

A Multidisciplinary Working Team of nine experts, with representation from the main stakeholders regarding MS, was set up to agree on a set of proposals to improve the management of MS. A forecast SROI analysis was carried out, with a one-year timeframe. Data sources included an expert consultation, a narrative literature review and a survey to 532 MS patients. We estimated the required investment of a hypothetical implementation, as well as the potential social value that it could create. We calculated outcomes in monetary units and we measured intangible outcomes through financial proxies.

Results

The proposed ideal approach revealed that there are still unmet needs related to MS that can be addressed within the SNHS. Investment would amount to 148 million € and social return to 272 million €, so each euro invested could yield almost €2 of social return.

Conclusions

This study could guide health interventions, resulting in money savings for the SNHS and increases in patients’ quality of life.

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Most cited references 31

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Comorbidity delays diagnosis and increases disability at diagnosis in MS.

R. Marrie, D Campagnolo, G. Cutter … (2009)

Comorbidity is common in the general population and is associated with adverse health outcomes. In multiple sclerosis (MS), it is unknown whether preexisting comorbidity affects the delay between initial symptom onset and diagnosis ("diagnostic delay") or the severity of disability at MS diagnosis. Using the North American Research Committee on Multiple Sclerosis Registry, we assessed the association between comorbidity and both the diagnostic delay and severity of disability at diagnosis. In 2006, we queried participants regarding physical and mental comorbidities, including date of diagnosis, smoking status, current height, and past and present weight. Using multivariate Cox regression, we compared the diagnostic delay between participants with and without comorbidity at diagnosis. We classified participants enrolled within 2 years of diagnosis (n = 2,375) as having mild, moderate, or severe disability using Patient Determined Disease Steps, and assessed the association of disability with comorbidity using polytomous logistic regression. The study included 8,983 participants. After multivariable adjustment for demographic and clinical characteristics, the diagnostic delay increased if obesity, smoking, or physical or mental comorbidities were present. Among participants enrolled within 2 years of diagnosis, the adjusted odds of moderate as compared to mild disability at diagnosis increased in participants with vascular comorbidity (odds ratio [OR] 1.51, 95% CI 1.12-2.05) or obesity (OR 1.38, 95% CI 1.02-1.87). The odds of severe as compared with mild disability increased with musculoskeletal (OR 1.81, 95% CI 1.25-2.63) or mental (OR 1.62, 95% CI 1.23-2.14) comorbidity. Both diagnostic delay and disability at diagnosis are influenced by comorbidity. The mechanisms underlying these associations deserve further investigation.

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Comorbidity in multiple sclerosis: implications for patient care

Ruth Marrie (2017)

Comorbidity is common in multiple sclerosis (MS). In this Opinion article, Ruth Ann Marrie discusses how comorbidity affects diagnosis, progression, mortality, and health-related quality of life in patients with MS, and how clinicians should incorporate the prevention and management of comorbidities when treating MS.

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Social Return on Investment (SROI) methodology to account for value for money of public health interventions: a systematic review

Aduragbemi Oluwabusayo Banke-Thomas, Barbara Madaj, Ameh Charles … (2015)

Background Increased scarcity of public resources has led to a concomitant drive to account for value-for-money of interventions. Traditionally, cost-effectiveness, cost-utility and cost-benefit analyses have been used to assess value-for-money of public health interventions. The social return on investment (SROI) methodology has capacity to measure broader socio-economic outcomes, analysing and computing views of multiple stakeholders in a singular monetary ratio. This review provides an overview of SROI application in public health, explores lessons learnt from previous studies and makes recommendations for future SROI application in public health. Methods A systematic review of peer-reviewed and grey literature to identify SROI studies published between January 1996 and December 2014 was conducted. All articles describing conduct of public health SROI studies and which reported a SROI ratio were included. An existing 12-point framework was used to assess study quality. Data were extracted using pre-developed codes: SROI type, type of commissioning organisation, study country, public health area in which SROI was conducted, stakeholders included in study, discount rate used, SROI ratio obtained, time horizon of analysis and reported lessons learnt. Results 40 SROI studies, of varying quality, including 33 from high-income countries and 7 from low middle-income countries, met the inclusion criteria. SROI application increased since its first use in 2005 until 2011, declining afterwards. SROI has been applied across different public health areas including health promotion (12 studies), mental health (11), sexual and reproductive health (6), child health (4), nutrition (3), healthcare management (2), health education and environmental health (1 each). Qualitative and quantitative methods have been used to gather information for public health SROI studies. However, there remains a lack of consensus on who to include as beneficiaries, how to account for counterfactual and appropriate study-time horizon. Reported SROI ratios vary widely (1.1:1 to 65:1). Conclusions SROI can be applied across healthcare settings. Best practices such as analysis involving only beneficiaries (not all stakeholders), providing justification for discount rates used in models, using purchasing power parity equivalents for monetary valuations and incorporating objective designs such as case–control or before-and-after designs for accounting for outcomes will improve robustness of public health SROI studies. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1935-7) contains supplementary material, which is available to authorized users.

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Author and article information

Contributors

Ester Moral Torres: estermoral@yahoo.es

Óscar Fernández Fernández: oscar.fernandez.sspa@gmail.com

Pedro Carrascal Rueda: pedro@emeuskadi.org

Elena Ruiz-Beato: elena.ruiz-beato@roche.com

Elvira Estella Pérez: elvira.estella@roche.com

Rita Manzanares Estrada: rita.manzanares@roche.com

Teresa Gómez-García: teresa.gomez@weber.org.es

Margarita Jiménez: margajt@gmail.com

Álvaro Hidalgo-Vega: alvaro.hidalgo@uclm.es

María Merino:

ORCID: http://orcid.org/0000-0002-5769-1821

maria.merino@weber.org.es

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 4 February 2020

Publication date PMC-release: 4 February 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 84

Affiliations

[1 ]GRID grid.417656.7, Neurology Service, Moisès Broggi Hospital – General Hospital of l’Hospitalet, ; Barcelona, Spain

[2 ]Neuroimmunology & Multiple Sclerosis, Institute of Biomedical Research of Malaga, Malaga, Spain

[3 ]Directorate, Esclerosis Múltiple España, Madrid, Spain

[4 ]Roche Farma España, Madrid, Spain

[5 ]Roche Farma España, Madrid, Spain

[6 ]Roche Farma España, Madrid, Spain

[7 ]Health Outcomes Research Department, Weber, Madrid, Spain

[8 ]Pharmacoeconomics and Market Access Department, Weber, Madrid, Spain

[9 ]ISNI 0000 0001 2194 2329, GRID grid.8048.4, Economy and Health Research Seminar, Universidad de Castilla-La Mancha, ; Toledo, Spain

[10 ]Health Outcomes Research Department, Weber, Calle Moreto, 17, 5 Dcha, 28014 Madrid, Madrid Spain

Author information

María Merino http://orcid.org/0000-0002-5769-1821

Article

Publisher ID: 4946

DOI: 10.1186/s12913-020-4946-8

PMC ID: 7001370

PubMed ID: 32019531

SO-VID: 04e3d908-22ae-4d92-9228-1c9fa116b420

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 4 June 2019

Date accepted : 29 January 2020

Funding

Funded by: Roche Farma

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ScienceOpen disciplines: Health & Social care

Keywords: multiple sclerosis,disease management,social value,social return on investment,sroi,spain

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: multiple sclerosis, disease management, social value, social return on investment, sroi, spain

Social value of a set of proposals for the ideal approach of multiple sclerosis within the Spanish National Health System: a social return on investment study

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Most cited references 31

Comorbidity delays diagnosis and increases disability at diagnosis in MS.

Comorbidity in multiple sclerosis: implications for patient care

Social Return on Investment (SROI) methodology to account for value for money of public health interventions: a systematic review

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