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Researchers Create, Validate Health Utilization Questionnaire for Multiple Sclerosis


An efficient, concise patient questionnaire gathering health utilization information is effective for patients with multiple sclerosis, according to researchers who created one.

The Multiple Sclerosis Health Resource Utilization Survey (MS-HRS) was an easy-to-use questionnaire that provided holistic and longitudinal information about patients with multiple sclerosis (MS), according to a paper published in the Journal of Medical Internet Research.

Investigators from Germany created a questionnaire in order to develop a MS health resource utilization survey that could be taken via smart tablets or on paper. The questionnaire was developed by a team of neurologists, health care administrators, psychologists, and MS nurses in 2009. A more time-efficient version was created in 2016 in order to be completed in 10-15 minutes.

Previous studies that examined resource utilization by MS patients analyzed secondary data, the study authors explained, such as administrative data from health insurance or health care providers, leading to study limitations. Combining a longitudinal approach with a questionnaire can allow for tracking of disease-modifying therapies (DMT), typical of early disease cost drivers, as well as indirect costs, a hallmark of later disease stages.

The investigators looked at 3 primary steps: identification of resource consumption, qualification of resource use, and valuation of resources. Costs were broken up into direct medical, direct nonmedical, and indirect costs, the study authors added.

There were 2207 patients with MS who completed the study. The cohort was predominantly female (73%), had a mean age of 41.7 years, and were mostly

employed (61%) with full-time work (59%), the investigators reported. About half of the patients had experienced a relapse in the previous 12 months.

A majority of the patients reported using direct medical services in the previous 3 months, the investigators found. However, only 44% reported indirect medical costs and only 16% had direct nonmedical costs. Besides DMTs, the study authors said, indirect costs were the main cost drivers prior to direct medical and direct nonmedical costs. Per quarter per patient, total cost was about €2462 (approx. $2658) without according to the study authors, and reached €7126 ($7693) with DMTs.

The authors also noted what type of treatment the patients received: mostly in private practices (85%), though less often during inpatient hospital stays (6%) and day care admissions (3%). The highest costs were for inpatient treatments (€315, $340), followed by consultations in the primary sector (€209, $225) and day admissions in hospitals (€32, $34).

Annual costs for mild-to-moderate MS were estimated to range between €9528 ($10,282) without DMTs and €28,203 ($30,435) with DMTs.

The authors believe the MS-HRS can be used efficiently as part of clinical interventions as well as noninterventional studies to collect economic data. The study has limitations, though, the researchers suggested. These include reliable recall periods in patients who may be cognitively affected by MS or patients who may not want to disclose what they may believe is confidential socioeconomic or health economic information.

“In a large population, we demonstrated that the questionnaire is easy to administer and has good psychometric properties,” the authors concluded.

“These characteristics provide the necessary prerequisites for high-quality health economic studies (eg, cost-effectiveness analyses)… The MS-HRS is a promising option to measure costs precisely in cross-sectional and longitudinal settings instead of estimating them or using surrogates.”

The MS-HRS is available online here: http://msz.uniklinikum-dresden.de/ehealth/ms-hrs


Ness NH, Haase R, Kern R, et al. The multiple sclerosis health resource utilization survey (MS-HRS): Development and validation study. J Med Internet Res. 2020;22(3):e17921.

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