Economic burden of multiple sclerosis in France estimated from a regional medical registry and national sick fund claims.

BACKGROUND: Estimating direct healthcare costs of patients with multiple sclerosis (MS) and identifying risk factors of high costs including relapse are important drivers of public health decision making in France. METHODS: This is a longitudinal retrospective study based on patient charts (qualified registry of MS in Lorraine (ReLSEP)) and claims data (from the main compulsory health insurance and national hospital database estimated monthly. All patients with MS not deceased or lost to follow-up reported in the registry in 2013-2014 were included. Outpatient costs were those paid to the healthcare provider and inpatient costs were those related to national cost estimates. Mean total costs per patient by disease severity were estimated monthly, accounting for MS evolution over the study period. Costs of MS relapse were estimated using a general linear model. RESULTS: A total of 4373 patients were identified in the ReLSEP registry, and 2166 of these patients were included in the study. Among those, outpatient claims were available for 1366 and 627 were hospitalized at least once. The average annual direct costs for patients with MS were estimated to be €12,296 in 2014. Furthermore, ambulatory costs represented 87.8% out of those costs and were mainly driven by medications (60.6%) and paramedic visits (11.2%). Monthly direct costs were higher in patients with severe disease (€1249 for EDSS 7-9) compared to those with mild or moderate disease (€992 for EDSS 0-3; €953 for EDSS 4-6) (p < 0,006). Interestingly, drug costs were higher in patients with mild disease, whereas costs related to paramedical care, medical devices, and transportation were higher in those with severe MS. The unit cost of relapse was estimated between €1681 and €2193. CONCLUSIONS: Costs were mainly driven by medications and highly related to disease severity. Relapse cost was the main contributor to total cost.

Does Clot Burden Score on Baseline T2*-MRI Impact Clinical Outcome in Acute Ischemic Stroke Treated with Mechanical Thrombectomy? / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: A long clot, defined by a low (0-6) clot burden score (CBS) assessed by T2*-MR sequence, is associated with worse clinical outcome after intravenous thrombolysis (IVT) for acute ischemic stroke than is a small clot (CBS, 7-10). The added benefit of mechanical thrombectomy (MT) might be higher in patients with long clot. The aim of this pre-specified post hoc analysis of the THRombectomie des Artères CErebrales (THRACE) trial was to assess the association between T2*-CBS, successful recanalization and clinical outcome. METHODS: Of 414 patients randomized in the THRACE trial, 281 patients were included in this analysis. Associations between T2*-CBS and clinical outcome on the modified Rankin Scale (mRS) at 3 months were tested. RESULTS: High T2*-CBS, i.e., small clot, was associated with a shift toward better outcome on the mRS; proportional odds ratio (POR) per point CBS was 1.19 (95% confidence interval [CI], 1.05 to 1.34) in the whole population, 1.34 (95% CI, 1.13 to 1.59) in IVT group, and 1.04 (95% CI, 0.87 to 1.23) in IVTMT group. After adjustment for baseline prognostic variables, the effect of the full scale T2*-CBS was not statistically significant in the whole population and for the IVTMT group but remains significant for the IVT group (POR, 1.32; 95% CI, 1.11 to 1.58). CONCLUSIONS: A small clot, as assessed using T2*-CBS, is associated with improved outcome and may be used as a prognostic marker. Despite the worst outcome with long clot, the relative benefit of MT over IVT seemed to increase with low T2*-CBS and longer clot.