Systematic review of the economics of multiple sclerosis in Latin America

Objectives: To summarize published articles dealing with economic issues related to multiple sclerosis (MS) in Latin America. Methods: We searched Medline, Embase, Scielo and LILACS using the key words nullmultiple sclerosisnull and nullesclerosis multiplenull plus nullLatin Americanull and all country names. Full articles or abstracts from meetings reporting original research on cost or economic analyses, budget impact or resource utilization were obtained. No restrictions were placed on publication date or language. All work was done in duplicate by two independent reviewers with adjudication by consensus discussion. Results: We identified 1482 papers, of which 27 were considered for analysis. There were 7 economic analyses (5 costeffectiveness, 2 cost-utility), 5 budget impact analyses, 10 cost analyses (6 drug expenditures and 4 cost of illness), 4 on resource utilization and 1 on productivity loss. Studies were obtained from 5 countries (18 Brazil, 3 Argentina, 3 Colombia, 2 Mexico, 1 Chile). Mostly (22/27, 81%) were published as abstracts; 5 were published as full text articles (19%). Dates for these publications ranged from 2002 to 2013, with an exponential increase over time. The number of MS patients is increasing rapidly (71% increase in Brazil between 2006 and 2009). However, hospitalization rates (overall and per patient) have been decreasing, as newer more effective drugs have been increasingly used. Disease modulating therapies are predominantly used. Costs of care are quite high and have risen dramatically, e. g. > 200% in Brazil between 2007-2012, with beta-interferons mostly used (78%). Some high cost drugs such as fingolimod and natalizumab have been found cost-effective over older drugs such as beta-interferons or glatiramer acetate in Mexico, Brazil and Colombia, with modest impact on budgets. Conclusions: Very little evidence related to cost of MS has been produced in Latin America. More research is needed to better support decisions regarding care of MS patients.