Krankheitskosten und gesundheitsbezogene Lebensqualität bei Patienten mit Multipler Sklerose

The current discussions and changes of the health care sector throughout Europe underline the growing impact of economic aspects in medicine. One of the elementary forms of health economic studies are cost of illness studies. They determine the annual mean cost of a patient with a given disease. Costs are calculated out of a social perspective, which means all costs caused by the disease are included. This study evaluated the cost of illness for multiple sclerosis (MS). MS, a chronical inflammatory disease of the central nervous system, affects also young people and counts among the most cost intense neurological diseases. Costs were collected with the help of a questionnaire for a period of three months. A further aspect of this work consisted of an exploration of the quality of life within patients affected by multiple sclerosis. It was conducted with the help of both general and specific instruments. 87 MS patients with an average age of 41.5 years took part in this study. The analysis resulted in total mean annual costs of 39 900 € per patient, 56.5% of which were direct costs, while the remaining part was caused indirectly by work loss or early retirement. Indirect costs rose in step with the severity of MS; the rate of persons, who were not working because of MS was 46%. The employment status correlated directly with the EDSS score. Direct costs per year and patient ammounted to 22 536 €, 14 319 € of which were drug costs. The second largest part were 3530 € for in-patient care. For direct costs the correlation between stage of disease and costs was not as obvious, because drug costs, which make up the biggest part of direct costs, decrease in the advanced stages of MS. As expected, quality of life decreased with higher levels of the disease. A significant negative influence was exerted by depression, fatigue, age and duration of the disease, as well as higher age at the time of diagnosis. Depression and fatigue had the highest correlation to quality of life. Both aspects stood in a strong relation to each other. Multiple sclerosis places a high burden on the affected persons, but also on scociety as a whole. By means of an optimal and early treatment it may be possible to delay early retirement. Thus indirect costs could be minimized and quality of life optimized. The high psychological toll of the illness suggests that only medical treatment is insufficient and must be supplemented in many cases by psychotherapy.