TMJ 'dysfunction' - Health implications

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Kobelt et al. Costs and quality of life of patients with multiple sclerosis in Europe. J Neurol Neurosurg Psychiatry. 2006 Aug;77(8):918-26.

OBJECTIVE: To assess overall resource consumption, work capacity and quality of life of MSers with MS in nine European countries.

METHODS: Information on resource consumption related to MS, informal care by relatives, productivity losses and overall quality of life (utility) was collected with a standardised pre-tested questionnaire from 13,186 MSers enrolled in national MS societies or followed up in neurology clinics. Information on disease included disease duration, self-assessed disease severity and relapses. Mean annual costs per patient (Euro, 2005) were estimated from the societal perspective.

RESULTS: The mean age ranged from 45.1 to 53.4 years, and all levels of disease severity were represented. Between 16% and 29% of MSers reported experiencing a relapse in the 3 months preceding data collection.

The proportion of MSers in early retirement because of multiple sclerosis ranged from 33% to 45%. The use of direct medical resources (e.g., hospitalisation, consultations and drugs) varied considerably across countries, whereas the use of nonmedical resources (e.g. walking sticks, wheelchairs, modifications to houses and cars) and services (e.g., home care and transportation) was comparable.

Informal care use was highly correlated with disease severity, but was further influenced by healthcare systems and family structure. All types of costs increased with worsening disease. The total mean annual costs per MSer (adjusted for gross domestic product purchasing power) were estimated at Euro 18,000 for mild disease (Expanded Disability Status Scale (EDSS) <4.0), Euro 36,500 for moderate disease (EDSS 4.0-6.5) and Euro 62,000 for severe disease (EDSS >7.0). Utility was similar across countries, at around 0.70 for a patient with an EDSS of 2.0 and around 0.45 for a patient with an EDSS of 6.5. Intangible costs were estimated at Euro 13,000 per patient.