Economic burden and health-related quality of life in restless legs syndrome

Objective: To assess the economic burden and health-related quality of life (HRQoL) in patients with Restless Legs Syndrome (RLS) in Germany

Background: RLS features a distressing, irresistible need or urge to move the legs often accompanied by sleep disturbances. The prevalence is about 5–10% in the general population. Although well-defined diagnostic criteria and effective treatment options exist, RLS is generally under-diagnosed and under-treated.

Methods: 519 patients (327 females; mean age: 64.2y) were recruited in 5 German centers according to the diagnostic criteria of the International RLS Study Group (IRLS). Patients completed a questionnaire consisting of sociodemographic, clinical, and health care resource consumption data. HRQoL was evaluated with the EuroQoL (EQ-5D/VAS). In addition, the IRLS scale, the Medical Outcome Study Sleep Scale, the Epworth Sleepiness Scale (ESS), and the Beck Depression Inventory (BDI) were applied as clinical rating scales. Direct and indirect costs (in 2006 Euro) were derived from various German economic resources and calculated from the societal perspective.

Results: HRQoL was substantially affected by RLS. The mean EQ VAS was 55.6 and considerably lower compared to the general population. It was found to be as low as in other chronic neurological disorders such as Parkinson's disease and stroke. From different factors investigated by uni- and multivariate analyses, severity of RLS and depressive symptoms had the most significant impact on HRQoL. Additionally, sleep deficits, the duration of the disease and net household income were identified as predictors for EQ-5D outcome scores. Health care resource use – calculated as average total costs over a 3-month observation period – were Eur2090 per patient. The direct medical and non-medical costs totalled to Eur780, with Eur300 attributed to drug costs and Eur354 to hospitalization costs. Total indirect costs amounted to Eur1308 and were calculated based on the productivity loss, using the human capital approach. As cost-driving factors disease severity according to IRLS and ESS were identified.

Conclusion: RLS has substantial impact on HRQoL and implies a considerable economic burden to the patients and society. Because of the high prevalence and the growing number of approved treatment options we assume further increase in RLS costs.