Multiple sclerosis patients’ preferences:consideration of their awareness and perception

Objectives: Multiple sclerosis (MS) is a disabling and progressive illness, representing one of the most common causes of disability in young adults. Disease-modifying drugs (DMDs) have shown to be effective in reducing the frequency and severity of exacerbations and the progression of disability. While the clinical efficacy of such therapies has been documented in the medical literature, the factors underlying the decision to start the pharmacological treatment or to drop it out, have not been studied so far. The present research, that constitutes an absolute novelty in the health economic literature, is aimed at evaluating the factors underlying the patients’ decisions to undergo a pharmacological treatment and to proceed it according to medical protocols. Methods: A sample of 935 patients diagnosed with MS has been observed at the Centro Studi Neurolesi (Messina, Italy). About one third of the patients in the sample assumes DMDs. The dependentqualitative– variable in the econometric analysis is the circumstance that patients take DMDs. The probabilities to start and to proceed regularly the therapy with DMDs have been estimated by applying a probit and an ordered logit model. Results: Results of the study provided, first of all, information about the elements that influence patients’ decision to start the therapy with DMDs; secondly, factors conditioning patients’ adherence to the treatment have been evaluated. Previous hospitalization due to the disease, and clinical symptoms such as difficulty in moving and balance, and parasthesias appeared to have the greatest importance. However, patients evaluated side effects provoked by DMDs as factors that greatly diminish quality of life and affect their compliance. Conclusions: This study provided useful information for: 1) the NHS, or whoever else is bearing the cost of DMDs: given the high costs induced by MS, a clear knowledge of the factors likely to induce a scarce adherence to the therapy and, consequently, to determine a higher probability of relapses for MS patients, helps in better allocating resources and reduce wastes. 2) Physicians, because knowing the factors perceived to be most critical in undergoing the treatment with DMDs helps them to implement effective communication strategies in order to achieve patients’ compliance. 3) Patients, because their active role is critical for the progression of the disease itself. They can get higher awareness of the disease and of the benefits associated to pharmacologic treatment. Results of the study lead, moreover, to a more precise definition of their preferences and to a higher quality of life.