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      Neuropsychiatric Disease and Treatment (submit here)

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      Epidemiology and costs of multiple sclerosis in Switzerland: an analysis of health-care claims data, 2011–2015

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          Abstract

          Background

          Medical therapy for multiple sclerosis (MS) is expensive. Quantifying the burden of MS is fundamental for health-care planning and the allocation of resources for the management of MS. This study provides current national estimates of prevalence, incidence, mortality, and costs of MS in Switzerland using claims data between 2011 and 2015.

          Methods

          We analyzed health insurance claims of adult persons enrolled with a large health insurance group covering about 13% of the Swiss population between 2011 and 2015. The identification of patients with MS was based on prescription data of MS-specific medication using the Anatomical Therapeutic Chemical Classification system as proxy for clinical diagnosis. We estimated prevalence, mortality, and costs of basic health insurance between 2011 and 2015. Furthermore, incidence of MS was calculated for 2015. All results were weighted with census data to achieve an extrapolation to the Swiss general population level. Cost of illness was estimated as direct medical cost from the perspective of a Swiss health insurance using multivariate linear regression analysis.

          Results

          Of the 943,639 subjects in the year 2015, 1,606 were identified as MS patients resulting in a prevalence of 190 per 100,000 (95% CI: 180−190 per 100,000). Incidence was 16 per 100,000 (95% CI: 13−19 per 100,000). According to regression analysis, the total cost of illness for basic mandatory health insurance was 26,710 Swiss Francs (CHF) (95% CI: 26,100–27,300) per person per year with the cost of medication being almost identical 26,960 CHF (95% CI: 26,170–27,800).

          Conclusions

          MS affects 10,000–15,000 persons in Switzerland, and the prevalence has increased over the last 22 years. These persons have high need and demand for health care. High costs are primarily due to expenses for medication. Given the imbalance of MS medication therapy from the perspective of basic health insurance on the disposable resources, it is crucial to increase transparency related to the volume, type, and allocation of expenses.

          Most cited references33

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          Identifying patients with chronic conditions using pharmacy data in Switzerland: an updated mapping approach to the classification of medications

          Background Quantifying population health is important for public health policy. Since national disease registers recording clinical diagnoses are often not available, pharmacy data were frequently used to identify chronic conditions (CCs) in populations. However, most approaches mapping prescribed drugs to CCs are outdated and unambiguous. The aim of this study was to provide an improved and updated mapping approach to the classification of medications. Furthermore, we aimed to give an overview of the proportions of patients with CCs in Switzerland using this new mapping approach. Methods The database included medical and pharmacy claims data (2011) from patients aged 18 years or older. Based on prescription drug data and using the Anatomical Therapeutic Chemical (ATC) classification system, patients with CCs were identified by a medical expert review. Proportions of patients with CCs were calculated by sex and age groups. We constructed multiple logistic regression models to assess the association between patient characteristics and having a CC, as well as between risk factors (diabetes, hyperlipidemia) for cardiovascular diseases (CVD) and CVD as one of the most prevalent CCs. Results A total of 22 CCs were identified. In 2011, 62% of the 932′612 subjects enrolled have been prescribed a drug for the treatment of at least one CC. Rheumatologic conditions, CVD and pain were the most frequent CCs. 29% of the persons had CVD, 10% both CVD and hyperlipidemia, 4% CVD and diabetes, and 2% suffered from all of the three conditions. The regression model showed that diabetes and hyperlipidemia were strongly associated with CVD. Conclusions Using pharmacy claims data, we developed an updated and improved approach for a feasible and efficient measure of patients’ chronic disease status. Pharmacy drug data may be a valuable source for measuring population’s burden of disease, when clinical data are missing. This approach may contribute to health policy debates about health services sources and risk adjustment modelling.
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            Cost of Illness of Multiple Sclerosis - A Systematic Review

            Background Cost-of-illness (COI) studies of Multiple Sclerosis (MS) are vital components for describing the economic burden of MS, and are frequently used in model studies of interventions of MS. We conducted a systematic review of studies estimating the COI of MS, to compare costs between studies and examine cost drivers, emphasizing generalizability and methodological choices. Material and method A literature search on studies published in English on COI of MS was performed in PubMed for the period January 1969 to January 2014, resulting in 1,326 publications. A mapping of studies using a bottom-up approach or top-down approach, respectively, was conducted for the 48 studies assessed as relevant. In a second analysis, the cost estimates were compared between the 29 studies that used a societal perspective on costs, human capital approach for indirect costs, presenting number of patients included, time-period studied, and year of price level used. Results The mapping showed that bottom-up studies and prevalence approaches were most common. The cost ratios between different severity levels within studies were relatively stable, to the ratio of 1 to 2 to 3 for disability level categories. Drugs were the main cost drivers for MS-patients with low disease severity, representing 29% to 82% of all costs in this patient group, while the main cost components for groups with more advanced MS symptoms were production losses due to MS and informal care, together representing 17% to 67% of costs in those groups. Conclusion The bottom-up method and prevalence approach dominated in studies of COI of MS. Our findings show that there are difficulties in comparing absolute costs across studies, nevertheless, the relative costs expressed as cost ratios, comparing different severity levels, showed higher resemblance. Costs of drugs were main cost drivers for less severe MS and informal care and production losses for the most severe MS.
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              Trends in survival and cause of death in Danish patients with multiple sclerosis.

              The Danish Multiple Sclerosis Registry contains information about all Danish patients in whom multiple sclerosis has been diagnosed since 1948. The purpose of this study was to analyse trends in survival and causes of death of these patients and to compare them with those of the general population. The study comprised all patients with onset in the period 1949-1996. All case records were validated and classified according to standardized diagnostic criteria. Data on emigration and death were obtained by record linkage to official registers. The end of follow-up was 1 January 2000 for emigration and death, and 1 January 1999 for cause-specific deaths. Standardized mortality ratios and excess death rates were calculated for various causes of death and periods after multiple sclerosis onset, and time trends in survival probability were analysed by Cox regression. The study comprised 9881 patients, of whom 4254 had died before end of follow-up. The median survival time from onset was approximately 10 years shorter for multiple sclerosis patients than for the age-matched general population, and multiple sclerosis was associated with an almost threefold increase in the risk for death. According to death certificates, more than half (56.4%) of the patients had died from multiple sclerosis. They also had excess mortality rates from other diseases, except cancer, and from accidents and suicide. The probability for survival improved significantly during the observation period. Thus, the 10-year excess mortality was almost halved in comparison with that in the middle of the 1900s.
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                Author and article information

                Journal
                Neuropsychiatr Dis Treat
                Neuropsychiatr Dis Treat
                Neuropsychiatric Disease and Treatment
                Neuropsychiatric Disease and Treatment
                Dove Medical Press
                1176-6328
                1178-2021
                2017
                01 November 2017
                : 13
                : 2737-2745
                Affiliations
                [1 ]Department of Health Sciences, Helsana Group, Zürich, Switzerland
                [2 ]Institute of General Practice, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
                [3 ]Division of General Practice, University Medical Center Freiburg, Freiburg, Germany
                [4 ]Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
                Author notes
                Correspondence: Eva Blozik, Department of Health Sciences, Helsana Group, Post Box CH-8081, Zürich, Switzerland, Tel +41 58 340 1111, Fax +41 58 340 0100, Email eva.blozik@ 123456helsana.ch
                Article
                ndt-13-2737
                10.2147/NDT.S143180
                5677381
                29138568
                4a6f70e8-e9da-4773-b5df-ed970a02d561
                © 2017 Blozik et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Original Research

                Neurology
                health insurance,switzerland,medication,prescription,management,resources
                Neurology
                health insurance, switzerland, medication, prescription, management, resources

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