Adults With MS, Comorbidities Shoulder Significant Economic, Health Burdens

The study authors hope their findings inform future interventions whose goal is to minimize the comorbidity burden of adults with multiple sclerosis (MS), thereby improving their quality of life and ultimate health outcomes.

A recent retrospective, cross-sectional, matched-cohort study investigated how comorbidities may influence the health care spending and physical and mental health status of patients with multiple sclerosis (MS) compared with healthy controls, with results highlighting significant economic and health burdens among the former.

These findings were published recently in ClinicoEconomics and Outcomes Research.

Medical Expenditure Panel Survey data from 2005 through 2015 were analyzed by the investigators on 1082 participants matched 1:1 to an MS cohort and a non-MS control group, based on age, gender, and race/ethnicity. Total and subtypes of expenditures were analyzed, too, while ordinary least squares regression and multinomial logistic regression analyzed the health care expenditures and health status variables, respectively.

“Existing studies on MS in the United States are older, lack generalizability, and do not focus on some of the important issues, such as health care resource use and expenditures and health status,” the authors wrote. “They also did not examine the effect of specific comorbidities on health care expenditure burden and did not use a robust study design.”

Overall, there was an almost 4-fold greater average total yearly spend among the MS cohort compared with the control group: $29,396 vs $7875 (P <.001). In fact, the total expenditures for the MS group were 363% higher (P <.001) than those for the non-MS controls, even after adjustment for individual-level factors.

In addition, worse physical status and just good mental health were more likely outcomes among individuals with MS:

  • Fair/poor physical health status had an HR of 4.10 (95% CI, 2.42-6.96) vs excellent/very good physical health status among the healthy controls.
  • Good mental health status had an HR of 1.42 (95% CI, 1.01-1.99) vs excellent/very good mental health status among the healthy controls.

No differences were seen between reporting fair and poor health status and very good or excellent mental health status.

After matching, the most common comorbidities among the MS group were musculoskeletal (46.3%), arthritis (42.1%), cardiometabolic (41.9%), psychiatric (41.2%), and depression (29.7%). All occurred at higher rates compared with the matched controls (31.0%, 30.1%, 41.2%, 19.0%, and 13.3%, respectively).

Regarding incremental health expenditures beyond yearly totals, emergency department (ED), outpatient, prescription, and home health agency costs were all significantly higher in the MS group:

  • ED: $718 vs $226
  • Outpatient: $5754 vs $2749
  • Prescription: $15,533 vs $1620
  • Home health agency: $1989 vs $218

Taking comorbidities into account, again expenses were elevated in the study group vs the control group:

  • Arthritis: $33,700 vs $12,345
  • Cancer: $44,954 vs $22,542
  • Diabetes: $39,579 vs $17,900
  • Eye problems: $36,999 vs $16,092
  • Heart disease: $40,389 vs $21,148
  • Depression: $36,380 vs $17,868
  • Osteoporosis: $37,002 vs $9926
  • Thyroid disease: $37,196 vs $17,401

Depression (odds ratio [OR], 4.81; 95% CI, 2.46-9.42) and anxiety (OR, 2.73; 95% CI, 1.25-5.98) additionally were associated with greater chances of reporting fair/poor physical health status.

“Findings from this US study indicate that comorbidities significantly influence economic and health status burden among adults with MS,” the authors concluded. “This study is one of the first steps in a continuum of research that is expected to inform the development of appropriate interventions to minimize the comorbidity burden among individuals with MS, which has the potential to improve quality of life and achieve other improved health outcomes.”


Bhattacharjee S, Yegezu Z, Kollecas K, Duhrkopf, Hashemi L, Greene N. Influence of comorbidities on healthcare expenditures and perceived physical and mental health status among adults with multiple sclerosis: a propensity score–matched US national-level study. Clinicoecon Outcomes Res. 2021;13:377-394. doi:10.2147/CEOR.S305154

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