Abstract
Introduction: Multiple sclerosis (MS) is a disabling inflammatory neurological disease. It presents diverse signs and symptoms due to the varied involvement of the motor, sensory, visual, and autonomic systems, resulting in devastating social and economic impacts. The disease affects young adults, causing disability and early absence from work. Objective: To assess the economic burden of MS on the Brazilian social security system from 2014 to 2023. Material and Method: Early benefits granted by the National Institute of Social Security (INSS) over a 10-year period (2014 to 2023) to beneficiaries with MS (ICD G35 and G35.0) were analyzed. Early benefits are those granted before the age of 65 for men and 60-62 for women, considering the legislation in force in each year. Beneficiaries' characteristics were analyzed, including age, sex, activity, and place of residence. The economic burden was assessed considering the quantity, duration (months) and expenses (in reais) related to each type of benefit. The duration of extended benefits (retirement and social assistance) was estimated considering the average Brazilian life expectancy, according to sex and age, with adjustment for excess mortality attributable to MS, and limited to the observed period and/or the expected retirement age. Expenses were calculated considering the duration and number of minimum wages granted, adjusted for inflation until December 2023. Results: from 2014 to 2023, 16,149 benefits for MS were granted in Brazil, 16,045 (99.4%) being early benefits (16,018 included in the economic burden analysis), at an average annual rate of 7.6 per million inhabitants. The average age at the time of granting was 38.6±9.8, with 68.8% women, 42.9% employees and 19.8% self-employed, 90.3% residents in urban areas and 49.0% commercial workers. The majority of benefits granted were aid (11,682, 72.9%), followed by retirements (3,175, 19.8%) and social support (1,167, 7.3%). The median (IIQ) of months of duration and amount paid per beneficiary of 4 (4-4) and R$6,456 (R$5,322-10,607) with aids, of 59.4 (32.8-81.8) and R$116,395 (R$65,029-195,638) with retirements, and of 26.6 (12.7-73.0) and R$35,886 (R$17,260-97,410) with support, respectively, accumulating a total loss of productivity of 284,612 months and total expenditure on benefits per EM of R$657,247,720 in the period. Conclusions: The economic burden of EM on the Brazilian social security system estimated for the last 10 years, in this study, represents a burden of more than R$657 million, mainly attributable to early retirements. Due to the disabling characteristics of the disease, retirement and absences occur at the peak of the individuals' productive age, potentially resulting in a negative balance between the contribution period and the total time away from work.
