Multiple sclerosis, which tends to strike at the height of people’s working years, can have a significant impact on their productivity at work, as well as an opportunity cost of being unable to do the work they want to do, said Larry Lynd, professor at the University of British Columbia’s faculty of pharmaceutical sciences, during a session supported by Biogen Inc. at Benefits Canada’s 2023 Chronic Disease at Work conference in early February.
For people with MS, the most common chronic neurological disorder affecting young adults in Canada, the immune system attacks a protective sheath that covers nerve fibres, causing communication problems between the brain and the body. The condition is most often diagnosed at around age 30 and 70 per cent of patients are women, said Lynd, noting roughly 100,000 Canadians have MS, making Canada one of the countries with the highest reported prevalences in the world.
Read: The importance of early intervention for employees with multiple sclerosis
The past two decades have seen meaningful advances in how MS is treated and managed, which have improved the health outcomes of patients. More treatment options are in the pipeline, said Lynd, and health professionals are working to try to treat people earlier on in their disease progression when it’s more likely to have an impact.
The average annual cost of MS is $6,800, including drugs, inpatient costs and hospitalization expenses, according to Lynd’s 20-year study of MS patients in B.C., which set out to capture the direct health-care costs associated with the disease by following these patients from 1997 to 2020.
The study found MS patients who experienced relapses in their symptoms saw their health-care resource utilization costs reach above $10,000 on average. For patients who were on higher-cost disease-modifying therapies, the average annual expense was about $13,000 per year, while patients who were more likely to be compliant and consistently use their disease-modifying therapy had an average annual expense of $24,000 per year.
In separate research, Lynd also found MS patients with comorbid conditions experienced higher annual health-care costs than people who didn’t have MS but were living with the same comorbid condition.
Read: What to expect for health benefits in 2020
“One could expect that, if you had cardiovascular disease, maybe the cost would be comparable to someone else in the control group with cardiovascular disease, but that’s not the effect,” he said. “That is certainly significant when it comes to comorbidity management and trying to reduce the overall impact of not just multiple sclerosis, but the comorbidities that our patients may have at the same time.”
Referring to the study, Lynd said those health-care expenses don’t capture the indirect cost burden of living with MS, such as patients and their caregivers being unable to work as much as they used to or at all. Given the age range when the disease tends to present, he said MS likely results in presenteeism.
Using the value of lost productivity questionnaire, developed by a colleague at UBC, he surveyed 512 Canadians with MS. About 56 per cent of respondents were disease-modifying therapy users and much of the respondent group had one or more comorbidities despite being relatively young, with an average age of 38.
Even though the vast majority (95 per cent) rated their disability level as quite low, 55 per cent experienced some lost productivity. That productivity loss accounted for about 10 per cent of their work time. The severity of someone’s MS was associated with presenteeism and unpaid lost work, but not absenteeism. The fatigue associated with MS had a real and regular impact on respondents’ daily activities and presenteeism.
Read: Head to head: Which is more disruptive — absenteeism or presenteeism?
“That makes sense,” he said. “People may . . . feel like they can go to work and they’re fatigued so maybe they don’t function at 100 per cent. Independent of whether we have a chronic disease or not, we’ve all had those days here and there. We’ve been able to show that if we could manage that, that would improve their productivity.
Lynd quantified the impact for employees with MS at roughly 4.5 hours over a three-month period of presenteeism at an average cost of $185. People who’d experienced an MS relapse were more likely to be off work for an extra 40 hours over a three-month period at a cost of about $2,800.
Patients’ disease severity correlates to an increased amount of time away from work and likelihood of being unemployed, he said. “Looking at the implications for treatment, if we can do a better job of the management of multiple sclerosis we can decrease the symptoms, we can manage the severity and ultimately improve quality of life for our patients, which is the primary goal.”
Read more coverage of the 2023 Chronic Disease at Work conference.