Care and Treatment Guarantee Plan for Patients with Multiple Sclerosis: Impact on Beneficiaries of the Chilean Public System 2008-2018

Multiple sclerosis (MS) is a pathology that mainly affects the young population, causing irreversible disability without treatment. The national multiple sclerosis program improves access to diagnosis, treatment, and prognostic of patients with relapsing-remitting multiple sclerosis (RRMS). Describe the biggest cohort of patients with RRMS in the Chilean public health system, analyze the impact of the national program in the clinical evolution and the diagnostic opportunity (time in years between the first outbreak and entry into the program) before and after 2010, date of incorporation of the pathology to the explicit health guarantees program (GES) of the Ministry of Health (MINSAL). A cross-sectional and retrospective study was carried out with the information extracted from 921 clinical records of patients with RRMS from 2008 to 2018. The impact on the clinical evolution was evaluated by comparing the initial EDSS with the control. Diagnostic opportunity was analyzed by comparing the data before and after 2010. Multivariate analysis was carried out to objectify its relationship with age, gender, clinical presentation, initial disability, and region of origin. The mean age of the patients was 34.5 years. The female-to-male ratio was 2.2:1. 40.5% of patients were admitted with EDSS (expanded disability status scale) greater than or equal to 3. At the clinical reevaluation, this percentage decreased to 32.5%. No demographic variable affected the diagnostic opportunity. Access to the RRMS program is not affected by age, gender, clinical presentation, disability, or region of origin, despite the unequal distribution of patients with RRMS in the country and the differences in access to diagnostic technologies in each of them.