Multiple Sclerosis (MS): costs to individuals, families and the economy
In 2017 there were 25,607 people with MS in Australia; that is 103.7 per 100,000. Total cost of MS was $AUD 1.75 bill and annual cost per person was $AUD 68,382 per annum. 13 MS affects people of working age and can lead to unemployment or underemployment. Twenty two percent of the direct per person cost ($8,437) were borne ‘out of pocket’ by the people with MS themselves, while government and community jointly incurred 78% of the direct per person costs ($21,911). The second largest component was the indirect costs from lost wages (32%, $21,858). Loss of wages has declined from 50% of direct costs to 32% in 2017, largely due to new generation of disease modifying therapies, which has allowed more people to remain in work. 13
Chen et al 14 report on MS days lost that there is a mean total absenteeism of 0.6 days per 4 weeks or 7.8 days per person annually. Symptom severity in people with MS most strongly explains workforce participation and productivity. 15 They assessed prevalence and impact of 30 comorbidities on participation and productivity in work, and the economic burden and productivity costs of comorbidities. Depression (45%) followed by anxiety (42%), allergies (38%), migraine (30%) and high blood pressure (25%) were the five most prevalent comorbidities. Those reporting limitations to activities had osteoarthritis, followed by depression, anxiety, and allergies.
Productivity loss in the past 4 weeks for those with comorbidities was 2.5 days, approximately 32.5 days per annum (highest for those with osteoporosis, inflammatory bowel disease, osteoarthritis and psoriasis), and 1.3 days, approximately 16.9 days per annum, without comorbidities. In addition, total population costs were greatest per year for those with depression with a cost of $AUD 33 mill; allergies at $AUD 33 mill; followed by anxiety, migraines and osteoarthritis. Higher numbers of comorbidities were associated with lost productivity: having one comorbidity compared to none led to 19.8% productivity loss.
These examples demonstrate that having chronic conditions has health impacts far beyond the health system itself. As well it increases inequalities between those with chronic conditions and those without since the health system takes no account of the value of social health.