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Patients With MS Face Substantial, but Differing, Burdens in Japan, EU, and US

Laura Joszt
Research comparing outcomes, resource utilization, and costs of multiple sclerosis (MS) found that patients with the disease face substantial burdens that differ among Japan, 5 European Union countries, and the United States.
The burden of multiple sclerosis (MS) is not uniform across countries, according to a study that compared outcomes, resource utilization, and costs of the disease among Japan, 5 European Union countries, and the United States. MS affects 2.5 million people around the world.

The study, published in ClinicoEconomics and Outcomes Research, compared the health status, work productivity loss, activity impairment, healthcare resource utilization, and annual costs associated with MS for 85 patients with the disease with 145,759 controls who did not have MS. The researchers also compared the health status of the Japanese patients with MS with that of 62 patients with MS in France, Germany, Italy, Spain, and the United Kingdom (5EU), and 67 patients with MS in the United States.

“Progression of MS is associated with a considerable burden on the individual, employers, health care system, and society,” the authors explained. “Patients with MS accrue financial burden due to lost work productivity and increased health care resource utilization and experience poor health status.”

The Medical Outcomes Study Short Form 36-Item Health Survey version 2 was used to assess health status and derived a mental component summary score (MCS) and a physical component summary score (PCS), as well as health state utility scores. Higher scores indicate better health status—scores on the MCS and PCS go up to 100, while scores on the health state utility score go up to 1.

The researchers also used the Work Productivity and Activity Impairment-General Health questionnaire to assess absenteeism, presenteeism, overall work impairment, and activity impairment. These factors were assessed as percentages with higher values indicating greater impairment. Finally, they assessed healthcare resource utilization by the number of healthcare provider visits, emergency department (ED) visits, and hospitalizations in the past 6 months.

Patients with MS were more likely to be female, be unemployed, have lower annual household income, and have significantly higher Charlson Comorbidity Index (CCI) scores in the unweighted sample. In the weighted sample of 85 patients with MS and 80 controls, patients with MS were younger and had higher CCI scores, but other parameters were not statistically different.

In the weighted sample, MS had a significant impact on the measures being studied. Compared with the controls, patients with MS had significantly lower MCS, PCS, and health state utility, and significantly higher absenteeism, presenteeism, overall work impairment, and activity impairment. In the previous 6 months, patients with MS also had more healthcare provider visits (16.8 vs 6.0), ED visits (0.75 vs 0.15), and hospitalizations (3.9 vs 1.0) compared with the controls.

After further controlling for age and CCI scores, patients with MS were found to have significantly higher costs than the controls. Costs for healthcare provider visits were $1297 for patients with MS compared with $768 for patients without and costs for hospitalizations were $1646 with MS and $415 without. The annual direct costs for patients with MS were $36,161.

In the comparison across countries, the authors found significant differences for demographic and health characteristics. For example, US patients were more likely to be older and less likely to be employed, whereas Japanese patients were less likely to exercise and had a higher CCI score.

In a weighted analysis in which the patients in the 5EU, Japan, and US groups had similar demographics and health characteristics, Japanese patients scored lower on the MCS but higher on the PCS compared with 5EU and US patients. The 5EU patients scored lower on the health state utility score than Japanese and US patients.

The authors suggested that Japanese patients with MS may have reported poorer mental health because there is a greater social stigma related to mental health in Japan compared with Western countries. As a result, these patients are less likely to seek treatment, which can exacerbate mental health conditions.

The authors noted that the findings should be used by healthcare providers and policy makers to find ways to reduce the burden on patients with MS in Japan.

“Cross-national differences in health status were also observed among patients with MS in Japan, the 5EU, and [United States], which suggests that the burden of MS is not uniform and may potentially be influenced, at least in part, by cultural factors,” they concluded. “Further study is required to study and compare the clinical aspects of MS across countries.”


Yamabe K, DiBonaventura MD, Pashos CL. Health-related outcomes, health care resource utilization, and costs of multiple sclerosis in Japan compared with US and five EU countries. Clinicoecon Outcomes Res. 2019;11:61-71. doi: 10.2147/CEOR.S179903.

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