Treatment experience,burden, and unmet needs (TRIBUNE) in Multiple Sclerosis study: the costs and utilities of MS patients in The Netherlands

Abstract

Background:

Multiple sclerosis (MS) is an important, highly disabling neurological disease, common among young adults in The Netherlands. Nevertheless, only a few studies to date have measured the burden imposed by MS on society in The Netherlands.

Objectives:

To estimate the cost and quality-of-life associated with MS in The Netherlands, while focusing on the burden of relapses and increasing disease severity.

Methods:

MS patients in The Netherlands (n?=?263) completed a web-based questionnaire which captured information on demographics, disease characteristics and severity (Expanded Disability Status Scale [EDSS]), co-morbidities, relapses, resource consumption, utilities, fatigue and activities of daily living (ADL).

Results:

Most patients included in the study were receiving treatment for MS (76% of the sample). The mean cost per patient per year increased with worsening disability and was estimated at €30,938, €51,056, and €100,469 for patients with mild (EDSS 0–3), moderate (EDSS 4–6.5), and severe (EDSS 7–9) disability, respectively. The excess cost of relapses was estimated at €8195 among relapsing-remitting patients with EDSS score ≤5. The quality-of-life of patients decreased with disease progression and existence of relapses.

Conclusions:

The cost of MS in The Netherlands was higher compared to the results of previous studies. The TRIBUNE study provides an important update on the economic burden of MS in The Netherlands in an era of more widespread use of disease-modifying therapies. It explores the cost of MS linked to relapses and disease severity and examines the impact of MS on additional health outcomes beyond utilities such as ADL and fatigue.

Conclusions:

Study limitations:     

Infinite inequality systems and cardinal revelations

Summary. Many economics problems are maximization or minimization problems, and can be formalized as problems of solving linear difference systems of the form and r _k -r _l > c _kl , for r-unknowns, with given c-constants. They typically involve strict as well as weak inequalities, with infinitely many inequalities and unknowns. Since strict inequalities are not preserved under passage to the limit, infinite systems with strict inequalities are notoriously hard to solve. We introduce a unifying tool for solving them. Our main result (Theorem 1 for the countable case, Theorem [2] for the not-necessarily-countable case) introduces a uniform solvability criterion (the -Axiom), and our proof yields a method for solving those that are solvable. The axioms economic intuition extends the traditional ordinal notion of revealed preference to a cardinal notion. We give applications in producer theory, consumer theory, implementation theory, and constrained maximization theory.Received: 21 May 2003, Revised: 29 October 2004, JEL Classification Numbers: C69, D21, D11, D82. Correspondence to: Marcel K. RichterWe thank Professor Leonid Hurwicz for helpful discussions, and a referee for helpful comments.     

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本文对美国穆迪、惠誉、标准普尔三大评级公司的主权评级模式进行了较为系统的介绍和评析。首先逐一简要介绍了三大评级公司各自的主权评级模式;并以此为基础分析了各模式的先天和后天两方面缺陷及其根源;最后总结了三大评级机构主权评级模式的五方面问题,并指出由其垄断国际评级的国际金融服务体系将面临重构。     

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