Discussion Papers, Department of Business and Management Science, Norwegian School of Economics (NHH)
The cost of multiple sclerosis in Norway – (and how certain can we be?)
(), Kjell-Morten Myhr, Harald Nyland and Jan H. Aarseth
Abstract: The research question initially formulated for this study
was to attempt to set a numerical target for the total yearly cost of MS to
the Norwegian society, and relate the cost and patients´ experienced
quality of life to illness severity. As work progressed, the question of
how much confidence may be put in this kind of information in Norway as for
today turned into another main issue. It turned out that much of the
information that could be used for our study was so imprecise or unreliable
that giving an impression that the information could be used to give an
acceptably precise single estimate of the cost of MS to the Norwegian
society would be seriously misleading. Therefore both “conservative” and
“best” estimates are given. A conservative estimate of the yearly cost of
MS to the Norwegian society around year 2002 is NOK 1 836 million. A best
estimate is NOK 4 033 million, more than twice the conservative estimate.
Mainly three factors account for the difference between the estimates:
Uncertainty on what elements should be included in cost-of-illness studies,
uncertainty on how some cost elements should be valued, and a combination
of differences in information on the same phenomena in different sources of
information and the researchers´ choices on how to handle them. For
decision making purposes the combined effect of differences in information
from different sources and the researchers´ choices on how to handle them
is most grave since it will usually go unrecognized.
When related to
illness severity, the total cost per patient to society seem to increase,
and the patients experienced quality of life to decrease, in a close to
linear fashion with increasing EDSS-levels 1. However, a warning should be
raised that because of the uncertainties as those mentioned, Norway
probably has a long way to go before studies like ours in general might be
regarded as providing acceptable information for decisions as important as
those that have to be made in the health sector.
1 The EDSS, Kurtzke`s
“Expanded Disability Status Scale”, is the most common tool used to express
illness severity in MS. The scale ranges from 0 (no disability) to 10 (dead
due to MS) and is divided in 20 half-point steps.
Keywords: Multiple sclerosis; cost-of-illness study; human-capital method; (follow links to similar papers)
JEL-Codes: I19; J24; (follow links to similar papers)
46 pages, October 11, 2006
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