La sclérose en plaques (SEP) appartient aux affections de longue durée (ALD) pour lesquelles les patients sont pris en charge à 100 % pour leurs dépenses de santé par la Caisse nationale d’assurance maladie des travailleurs salariés (CNAMTS). La CNAMTS assure 87 % de la population française. Les objectifs de cette étude étaient d’évaluer les coûts médicaux directs et indirects de la SEP parmi la population assurée par la CNAMTS en France en 2004. Les données comprenaient les différents coûts liés à la SEP en 2004. Nous avons calculé le coût global direct et indirect de la SEP, le coût direct et indirect par patient et les différents postes de dépenses. En 2004, 49 413 patients bénéficiaient d’une ALD pour SEP. Le coût direct de la SEP représentait 469 719 967 €. Le coût direct par patient et par an était de 9506 €. Les différents postes de dépenses comprenaient les traitements (44,5 %), les hospitalisations (27,9 %), les soins infirmiers (5,8 %), la kinésithérapie (5,7 %), les transports (4 %), la biologie (1,1 %) et les autres dépenses (1,5 %). Les coûts indirects étaient estimés à 116 millions d’euros en 2004. L’impact économique de la SEP en France est important comparable à celui du VIH.

Multiple sclerosis (MS) is one of the 30 chronic conditions specifically listed by the French healthcare system as a long-term disease (affections de longue durée [ALD]) for which the main health insurance fund (Caisse nationale d’assurance maladie des travailleurs salariés [CNAMTS]) provides full (100%) coverage of healthcare costs. The CNAMTS insures 87% of the French population (52,359,912 of the 60,028,292 inhabitants). The objectives of this study were to evaluate the direct and indirect medical costs of MS among the entire population insured by the CNAMTS in France in 2004. The CNAMTS provided us with access to the ALD database of patients with MS that contains different MS-related expenditures made in 2004. We calculated the overall direct and indirect cost of MS and the cost per patient and per item of expenditure. In 2004, 49,413 patients were registered on the ALD list for MS. Direct cost for MS patients was 469,719,967 €. The direct cost per patient and per year was 9,506 € with variations between regions (French administrative divisions) ranging from 10,800 € in northeastern France (Champagne-Ardenne) to 8,217 € in western France (Pays de la Loire). The different items of expenditure were treatments (44.5%), hospitalization (27.9%), nursing care (5.8%), physiotherapy (5.7%), transport (4%), biology (1.1%), and other (1.5%). During the course of the disease, the overall cost of MS increased slowly during the first 15 years (from 8,000 to 11,000 €), but dramatically the last year of life (23,410 €). The costs of immunomodulator treatments were higher during the first six years after registration on the ALD list. Conversely, physiotherapy costs increased linearly with time during the course of MS. Indirect costs were an estimated 116 million euros in 2004. A disability pension (8,918 € per patient) was perceived by 9,430 patients (19.1%) and a daily allowance (3,317 € per patient) by 9,894 patients (20%). In France, MS has an important economic impact, comparable to human immunodeficiency virus infection.