Table 2.
Study methodologies and costs per patient adjusted to 2019 US dollars after using Purchasing Power Parities (PPP) and 2019 Consumer Price Index (CPI)
| Study, country | Epidemiology and study design | Study perspective | Data source | Production losses and informal care approach | Year of costing | Currency | Total direct costs | Total indirect costs | Total costs | Total costs per patient uprated to $US, year 2019 values |
|---|---|---|---|---|---|---|---|---|---|---|
| Bottom-up studies | ||||||||||
| Ysrraelit et al. [43], Argentina | Prevalence-based, cross-sectional, retrospective | Societal | Patients via questionnaire; price list from public sources in Argentinaa; statistics on cost of labor and wages | HCA for production losses; opportunity cost for informal care | 2012 | Argentine peso | 161,190 (94%) | 10,129 (6%) | 171,322b,c | 58,616 |
| Kobelt et al. [44], Brazil | Prevalence-based, cross-sectional, retrospective | Societal and payer | Patients via questionnaire; price list from SUS; statistics on cost of labor and wages | HCA for production losses; opportunity cost for informal care | 2016 | Brazilian real | 27,355 (81%) | 6517 (19%) | 33,872 | 15,540 |
| da Silva et al. [48], Brazil | Prevalence-based, cross-sectional, retrospective | Brazilian household and healthcare system | Patients via questionnaire; price list obtained from Brazilian official price listsd | Productivity-related variables analyzed only to describe overall impact of MS for pts, without converting into monetary values | 2012 | Brazilian real | 38,509 (100%) | NR | 38,509b | 26,400 |
| Boyko et al. [47], Russia | Prevalence-based, cross-sectional, retrospective | Societal | Patients via questionnaire; price list from public sources; statistics on cost of labor and wages | HCA for production losses; opportunity cost for informal care | 2015 | Russian ruble | 522,125 (78%) | 148,746 (22%) | 670,729c | 30,358 |
| Karabudak et al. [45], Turkey | Prevalence-based, cross-sectional, retrospective | NR | Patients via questionnaire; price lists from different sourcese; statistics on cost of labor and wages | HCA for production losses; opportunity cost for informal care | 2011 | Turkish lira | 17,855 (95%) | 845 (5%) | 18,700 | 21,755 |
| Torabipour et al. [46], Iran | Prevalence-based, cross-sectional, unclear whether study was prospective or retrospective | NR | Patients via questionnaire; price list from the National book of Medical and the Diagnosis Tariff and National Commission of drug pricing; statistics on cost of labor and wages | HCA for production losses; opportunity cost for informal care | 2012 | Iranian rial | 32,167,380 (93%) | 24,084,92 (7%) | 34,575,876f | 6247 |
| Imani et al. [55], Iran | Prevalence-based, cross-sectional, retrospective | Household | Patients via questionnaire and clinical records; data sources for costs not reported | HCA for production losses; informal care calculation method not clearly reported | 2018 | Iranian rial | 92,308,240 (95%) | 5,213,500 (5%) | 97,521,740 | 7476 |
| Chanatittarat et al. [54], Thailand | Prevalence-based, retrospective | Societal | Patients via questionnaire and electronic health record databaseg; data sources for costs NR | HCA for production losses and informal care | 2017 | Thai baht | 353,623 (78%) | 97,141 (22%) | 450,764b | 36,237 |
| Top-down studies | ||||||||||
| Maia Diniz et al. [49], Brazil | Prevalence-based, retrospective Cohort | Brazilian Ministry of Health | Data on MS spending from patient-centered registry; price list from the SUS | NA | 2000–2015 | Brazilian realh | 26,370 for 2007i | NA | 26,370 | 28,207 |
| Muñoz-Galindo et al. [50], Colombia | Prevalence-based, cross-sectional, retrospective | Third-party payer | Data on records, medical history and claims from the information system of the insurer; price list obtained from several sourcesj | NA | 2010–2014 | Colombian pesos | 45,416,407 for 2014k | NA | 45,416,407b | 39,731 |
| Macias-Islas et al. [53], Mexico | Prevalence-based, retrolectivel observational | Mexican Social Security Institute institutional | Data from individual clinical records; unitary costs from the medical attention and diagnosis-related groups | NA | 2009–2011 | Mexican pesos | 274,930 for 2010m | NA | 274,930b,c | 41,514 |
| McKenzie et al. [51], Syrian and Iraqi refugees in Jordan | Prevalence-based, cross-sectional, retrospective | NR |
Data from refugees’ applications for emergency or exceptional medical care; data sources for costs NR |
NA | 2012–2013 | Jordanian dinar | 2,664 for 2012m | NA | 2664b | 9523 |
| Min et al. [52], China | Prevalence-based, retrospective | NR | Data from registers on disease diagnosis, medical expenses, and insurance coverage from the national database; healthcare cost obtained from CHIRA’s insurance database | NA | 2014–2016 | Chinese yuan | 1681 for 2015m | NA | 1681 | 463 |
| Du et al. [56], China | Prevalence-based, retrospective | Unclearn | Data from China Medical Insurance Research Association database; data sources for costs NR | NA | 2014 | Chinese yuan | 24,578 | NA | 24,578c | 6982 |
NR not reported, SUS Brazilian National Health System, PPP for 2017 was used for the study by Imani et al. [55] since the PPP for 2018 was not published
aThe Instituto Nacional de Estadísticas y Censos, the Nomenclador Nacional, drugs public price list and costs from the Sanitary and Clinical Effectiveness Institute cost database
bTransformed to local currency with exchange rate stated in the article
cTo obtain the cost per patient per year, we calculated the weighted average
dBrazilian official price lists, including Brazilian Ministry of Health, Unified Health System Management System of the Table of Procedures, Medicines, Orthotics, Prosthetics and Special Materials, SUS Supplementary Health System, and Brazilian Medical Association
ePrice list obtained from several sources: Turkey Public Expenditure Review and Social Security Institution, World Health Organization estimates of unit costs for patient services for Turkey and the Turkey Public Expenditure Review; Ministry of Health, and published literature
fTo obtain the cost per patient per year, transformations were made to estimate 1-year costs, assuming no seasonal variations in resource use
gData on direct non-medical and indirect costs collected via face-to-face structured interview using a questionnaire; data on direct medical costs collected from an electronic health record database of three MS clinics
hTransformed to local currency using the World Bank exchange rate ($US 1 = BRL 1,947), since no exchange rate was stated in the article. https://data.worldbank.org/indicator/PA.NUS.FCRF?end=2016&locations=CO&start=2000
iTotal direct medical costs in 16 years of the follow-up $US2,308,393,465.60; mean annual expenditure per patient $US13,544.40. We assumed the mean annual expenditure per patient was for the year 2007 (the middle year of the study between 2000 and 2015)
jPrice list obtained from several sources: the tariff manual for medical, surgical, and hospital procedures issued by the Ministry of Health and Social Protection and also based on previous contracts and negotiations between the insurer, and the health services companies during follow-up period
kThe average annual cost per patient in US dollars for Colombia was 29,339.53 (2010), 20,956.11 (2011), 23,892.63 (2012), 24,147.80 (2013), and $22,687.57 (2014). We considered in our analysis the annual cost per patient for the year 2014
lRetrospective, according to Feinstein’s definition, means that the treatment has already been started before the onset of the study, and data were collected prospectively
mTo obtain the cost per patient per year, we assumed that costs were equal during the years of study
nAuthors stated that “the study aims to evaluate the costs of MS imposed on society at large and individuals in urban areas of China.” The study perspective was unclear