The burden in treating children with multiple sclerosis (MS) in terms of hospitalizations and doctor visits is extremely high, especially in the first year after diagnosis, a study from Canada reports.
The study, “High rates of health care utilization in pediatric multiple sclerosis: A Canadian population-based study,” was published in PLOS One.
MS is a progressive, neurodegenerative, and autoimmune disease that commonly manifests during adulthood in a broad range of symptoms that can include difficulties with movement (motor impairments), and cognitive and emotional changes. In about 5% of patients, however, such symptoms start to become evident in childhood or adolescence.
Advances in understanding the disease’s development and progression, as well as in new and more targeted therapies, have significantly reduced health care burden among adults with MS.
“Affected adults have higher rates of health care utilization as compared to age and sex-matched adults without MS, but utilization in this population has changed over time, most notably due to a decrease in hospitalization rates,” the researchers wrote. “However, relatively little is known about health care utilization in the pediatric MS population.”
U.S. and Canadian researchers set out to compare the health care utilization of children with MS to age-, sex-, and geographically-matched children without the disorder.
The population-based, retrospective study used administrative health claims among people living in Ontario between 2003 and 2014 that had been stored at databases held at the Institute for Clinical Evaluative Sciences (ICES).
Children and adolescents with MS were identified using a validated definition based on a series of clinical diagnostic criteria for MS. For each child with MS that was identified, up to five non-afflicted children of the same age, sex, region of residence, and socioeconomic status were included into a control group.
A total of 659 cases of children with MS and 3,294 matched controls were identified, and rates of hospitalizations and health care services use in each group analyzed.
Researchers found that MS children were about 15.2 times more likely to be hospitalized compared to the other children. Rates of ambulatory physician visits, including both primary and specialty care like ophthalmology and neurology, were about 4.58 times higher in children with MS.
Detailed analysis found that the odds of hospitalization and ambulatory physician visits were particularly higher in MS children during the first year after diagnosis, being 40.1 and 5.14 times higher than in healthy children, respectively. These rates gradually declined over the following years, despite remaining much higher in MS children than those seen in the control group.
“The burden of health care use in the pediatric MS population is high, and substantially exceeds health care use in an age, sex, and geographically-matched pediatric population without MS,” the researchers wrote. “Health care use is particularly high during the year of diagnosis, and remains elevated thereafter.”
Specialty care needs are “consistent with the increased risk of mental health and behavioral concerns in MS, and frequent involvement of the eyes (optic neuritis), and potentially physically disabling relapses … [and] highlights the importance of multidisciplinary care in pediatric MS,” the study concluded.