Researchers Examine MS Gender Differences in Direct, Indirect Costs

The German multiple sclerosis (MS) study found differences by gender for some costs, but the overall economic burden of the disease was about the same.

A recent study from Germany found that spending on certain costs differed between men and women with multiple sclerosis (MS) in ways similar to the general population, but that overall economic burden was about the same.

Differences were seen between genders in direct and indirect costs, including outpatient visits, caregiving, and disability costs.

Historically, women have a higher incidence of MS than men in most developed countries, with ratios ranging from 2:1 to 4:1. Research on gender differences within MS mainly focused on biological and behavioral differences rather than health economic impacts.

“However, cost-of-illness analyses are valuable to inform about the diverse impact of MS and thus help decision makers to allocate scarce resources,” noted investigators in the report, published in Therapeutic Advances in Neurological Disorders.

Additionally, decisions regarding treatment for women is heavily influenced by pregnancy plans because disease onset typically occurs during childbearing years. As a result, many women experience disease progression because of discontinuation of treatments intended to slow neurological impairments and disability accumulation.

Researchers said they wanted to seek out the ways that use of health care resources and the societal costs differ between men and women. Societal costs encapsulate both direct costs, which was defined as referring to resources attributable to health care services, and indirect costs, which was defined as referring to work-related losses such as leaves of absences or impaired work performance.

Investigators analyzed pooled data derived from 2 prospective, observational, non-interventional phase 4 cohort studies from Germany. A total of 2095 patients with relapsing-remitting MS were eligible for analysis, with a mean age of 41.85 [10.13] years and a mean disease duration of 7.55 [6.12] years. The women-to-men ratio was 2.7:1; 79.2% (1528) of patients were female.

Overall, health care costs did not significantly differ between genders. The total quarterly costs for women were €2329 (US$2820.79) and were €2361 (US$2859.55) for men (P = .534).

Indirect costs accounted for more than 82% of the total cost for men and women, making it the main cost driver, followed by direct medical and direct non-medical costs.

In total, direct costs did not differ significantly being genders.

However, women utilized significantly more direct medical resources, such as specialist consultations (incidence rate ratio [IRR] 1.16; 95% CI 1.04–1.31, P = .011), bandages and other medical consumables (IRR 2.53; 95% CI 1.9–3.8, P = .001), professional caregivers and at-home medical assistance (IRR 2.50;95% CI 1.44–4.36, P < .001), and complementary medicine (IRR 2.41; 95% CI 1.14–5.06, P = .021) than their male counterparts.

Investigators said these finding were similar to those found in previous research on health care seeking behavior in the general population.

Also, researchers theorized that women may have sought medical care more often because they are typically see providers for reproductive health issues and screenings for breast or cervical cancer.

Men may have sought less often as they were statistically significantly more likely to live alone.

Total indirect costs were not significantly different between men and women. However, men were significantly more likely to have with impaired work performance or productivity (53.8% vs 45.5%, P < .001).

Women were more likely to be receiving greater amounts of disability payments; however, the authors noted this may not be linked to MS specifically In Germany, women are underrepresented in the workplace and often carry out the bulk of domestic responsibilities and childcare for the household.

The gender employment gap for study participants was 11.8%, which was consistent with that of the general population of Germany (10.2%) and Europe (12.5%). Similarly, the rate of male (10.5%) and female (48.1%) employees who had reduced working hours was also comparable to the general population (8.5% for men, 46.2% for women).

Investigators said that although indirect costs were not significantly impacted by gender, the data utilized in their analysis did not take into account any unpaid work that could not be done as a result of MS.


Schriefer D, Ness N-H, Haase R, Ziemssen T. Gender disparities in health resource utilization in patients with relapsing–remitting multiple sclerosis: a prospective longitudinal real-world study with more than 2000 patients. Ther Adv Neurol Disord. Published online October 24, 2020. doi: 10.1177/1756286420960274