Economic burden of multiple sclerosis in low- and middle-income countries: a case study from Lebanon

This thesis reviews the economic evaluation guidelines (EEGs) in Low- and Middle-Income Countries (LMICs) and explores the economic burden of multiple sclerosis (MS) in these countries, with a focus on the case of Lebanon. Our results show that there is an absence of evidence which could be provided by EEGs and by cost-of-illness (COI) studies on MS in low-income countries (LICs) and that existing guidelines and COI studies of MS in LMICs are limited and their quality is questionable. However limited, the studies suggest that MS imposes a significant economic burden in LMICs, as consumption of health resources and associated costs increase as the disease progresses.
We provide evidence on methodologies that can be used as a guideline for future studies on the economic burden of disease, as well as empirical recommendations for valuing costs in periods of financial and economic crisis, characterized by high fluctuations in price, particularly relevant in LMICs. Finally, we use these methodologies and recommendations to conduct a societal COI and Health-Related Quality of Life (HRQoL) study in Lebanon. Our results reveal the huge economic burden of MS on the Lebanese healthcare system and society. We reported high total annual costs per patient, 12.4 times higher than the nominal GDP per capita. The HRQoL of Lebanese MS patients deteriorated significantly and gradually as MS progressed, resulting in low utility scores for patients with higher Expanded Disability Status Scale (EDSS) levels and lower neurological functioning.
Accordingly, our findings provide relevant material to assist health economic researchers and policymakers in LMICs in developing EEGs and guidelines for conducting and reporting on COI and quality of life (QoL). In addition, the results of this thesis provide insights for Lebanese public health policymakers about the precise economic impact that MS imposes on Lebanese society in terms of societal costs and HRQoL in general, and specifically in light of the prevailing economic and financial crises that further contributed to the scarcity of health resources.