50
Percent
40 30 20 Total Women Men
Figure 167 Sweden
10 0
02
03
04
05
06
07
08
09
10
11
Estimated percentage of patients with secondary progressive multiple sclerosis who were being treated with immunomodulators. Source: Swedish Multiple Sclerosis Registry
Drugs have been approved since the 1990s for reducing the frequency of relapses in multiple sclerosis patients during the first 15 years before the progressive phase normally takes over. Studies have found that even the early stages of multiple sclerosis often give rise to irreversible damage, even though the symptoms are still mild. Thus, it is increasingly evident that immunomodulatory therapy must start early. The Swedish MS Association (SMSS), an independent organisation of caregivers and researchers, issues recommendations for the use of immunomodulatory therapy. According to the association, approximately 75 per cent of patients with relapsing-remitting multiple sclerosis meet the criteria for therapy, as opposed to a small percentage of those with secondary progressive multiple sclerosis (Indicator 168). Use of the therapy among the latter population is limited to the transition period out of the relapsing-remitting stage, which may last for several years. This report presents two different indicators of immunomodulatory therapy. The first indicator concerns early, relapsing-remitting multiple sclerosis, and the second indicator concerns the secondary progressive stage. Figure 167 shows the percentage of patients with relapsing-remitting multiple sclerosis who were receiving an immunomodulator among those who had the disease for less than 15 years. The comparison includes 3 063 patients who were being treated on 31 December 2011, as related to the estimated number of patients in each county. Estimated prevalence is based on data in the Swedish Multiple Sclerosis Registry and National Patient Register. A total of 46.6 per cent of the presumed patients nationwide were receiving treatment. The counties ranged from less than 26 per cent to more than 79 per cent. One likely source of error is underreporting to the quality register. Another cause for uncertainty stems from the estimate of how prevalent the disease is in the vari-
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QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2012