Burden of illness in multiple sclerosis (DEFENSE) study: the costs and quality-of-life of Finnish patients with multiple sclerosis

J Med Econ. 2016;19(1):21-33. doi: 10.3111/13696998.2015.1086362. Epub 2015 Sep 11.


Objective: Although multiple sclerosis (MS) is one of the most common causes of non-traumatic disability among young adults, no published data on its economic and health-related quality-of-life (HRQoL) burden is available from Finland. The DEFENSE study aimed to estimate the costs and HRQoL of patients with MS (PwMS) in Finland and explore how these variables are influenced by disease severity and relapses.

Methods: Overall, 553 PwMS registered with the Finnish Neuro Society, a national patient association in Finland, completed a self-administered questionnaire capturing information on demographics, disease characteristics and severity (Expanded Disease Severity Scale [EDSS]), relapses, resource consumption and HRQoL.

Results: The PwMS had a mean EDSS score of 4.0. Overall, 44.1% had relapsing-remitting form of the disease (RRMS). The mean age was 53.8 years and 55.7% had retired prematurely due to MS. Disease-modifying therapies (DMTs) were used by 42.7% of the study population, and 21.5% across all disease types and severities had experienced relapses during the previous year. The mean total annual cost of MS was €46,994, which increased with advancing disease from €10,835 (EDSS score = 0) to €109,901 (EDSS score = 8-9). The mean utility was 0.644. HRQoL decreased with increasing disease severity. Relapses imposed an additional utility decrement among the PwMS with RRMS and EDSS ≤5 and had a trend-like effect on total costs.

Limitations: The cross-sectional setting did not allow assessment of the significance of relapses in early MS or the use of DMTs on the prognosis of the disease.

Conclusion: The study confirms previous findings from other countries regarding a significant disease burden associated with MS and provides, for the first time, published numerical estimates from Finland. Treatments that slow disease progression and help PwMS retain employment for a longer duration have the highest potential to reduce the disease burden associated with MS.

Keywords: Burden of illness; Costs; Finland; MS; Multiple sclerosis; Quality of life; Utilities.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absenteeism
  • Adult
  • Aged
  • Aged, 80 and over
  • Cost of Illness
  • Cross-Sectional Studies
  • Efficiency
  • Female
  • Finland
  • Health Expenditures / statistics & numerical data
  • Health Services / economics
  • Health Services / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Models, Econometric*
  • Multiple Sclerosis / drug therapy
  • Multiple Sclerosis / economics*
  • Quality of Life
  • Recurrence
  • Retirement / economics
  • Retrospective Studies
  • Severity of Illness Index*
  • Socioeconomic Factors