Article

Multiple sclerosis (MS) is one of the 30 chronic conditions specifically listed
by the French healthcare system as a long-term disease (affections de longue
duree [ALD]) for which the main health insurance fund (Caisse nationale
d'assurance maladie des travailleurs salaries [CNAMTS]) provides full (100%)
coverage of healthcare costs. The CNAMTS insures 87% of the French population
(52,359,912 of the 60,028,292 inhabitants). The objectives of this study were to
evaluate the direct and indirect medical costs of MS among the entire population
insured by the CNAMTS in France in 2004. The CNAMTS provided us with access to
the ALD database of patients with MS that contains different MS-related
expenditures made in 2004. We calculated the overall direct and indirect cost of
MS and the cost per patient and per item of expenditure. In 2004, 49,413 patients
were registered on the ALD list for MS. Direct cost for MS patients was
469,719,967 euro. The direct cost per patient and per year was 9,506 euro with
variations between regions (French administrative divisions) ranging from 10,800
euro in northeastern France (Champagne-Ardenne) to 8,217 euro in western France
(Pays de la Loire). The different items of expenditure were treatments (44.5%),
hospitalization (27.9%), nursing care (5.8%), physiotherapy (5.7%), transport
(4%), biology (1.1%), and other (1.5%). During the course of the disease, the
overall cost of MS increased slowly during the first 15 years (from 8,000 to
11,000 euro), but dramatically the last year of life (23,410 euro). The costs of
immunomodulator treatments were higher during the first six years after
registration on the ALD list. Conversely, physiotherapy costs increased linearly
with time during the course of MS. Indirect costs were an estimated 116 million
euros in 2004. A disability pension (8,918 euro per patient) was perceived by
9,430 patients (19.1%) and a daily allowance (3,317 euro per patient) by 9,894
patients (20%). In France, MS has an important economic impact, comparable to
human immunodeficiency virus infection.
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Langue : FRANCAIS