{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T15:24:44Z","timestamp":1772551484234,"version":"3.50.1"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T00:00:00Z","timestamp":1669939200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T00:00:00Z","timestamp":1669939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Multiple sclerosis (MS) is a chronic, inflammatory disease of the central nervous system, commonly diagnosed during young adulthood. The proportion of direct and indirect costs of MS vary across settings. The International Multiple Sclerosis Study, involving 1152 patients with MS from 19 countries, reported the average annual costs per patient to be \u20ac41,212, with direct medical costs of \u20ac21,093, direct non-medical costs of \u20ac2110, and \u20ac16,318 marked as indirect costs. However, there are no precise data on the economic burden of MS in Slovakia. Therefore, the main objective of this study is to assess the economic impact of MS in Slovakia by identifying and measuring the direct medical costs and indirect costs of this disease.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We conducted a retrospective prevalence-based cost-of-illness analysis for MS in Slovakia sourced from the third-party payer and societal perspective. Patient co-payments and out-of-pocket expenses were not included in our study. We analysed all available costs and healthcare resources utilised in a 6-years period, from 2015 to 2020. For each year, all costs (in euro) were specified as total and the average annual cost per patient.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The estimated total economic burden of MS in Slovakia in 2020 was \u20ac57,347,523, with direct medical costs estimated to be \u20ac53,348,337 and indirect costs standing at \u20ac3,999,186. The total annual cost per patient in 2020 was \u20ac6682. Over the 6 years, the total diagnostic and treatment cost of patients with MS was estimated to be \u20ac283,974,236. With an average year-by-year increase of 5%, the total direct costs of MS had significantly grown during the examined 6 years. The total cost due to the MS-associated loss of productivity in these 6 years was \u20ac16,633,798. The average year-by-year increase of indirect costs of MS was 20%.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Our study revealed the substantial health and economic burden of  MS, with the average annual cost per patient to be approximately \u20ac6,682 in 2020. We provide the first extensive assessment of the burden of MS on Slovakian patients, the healthcare system, and society. It indicates the need for a detailed analysis of the employment of patients with MS to assess disability and work performance and the development of allied health policies.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12913-022-08883-6","type":"journal-article","created":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T08:31:26Z","timestamp":1669969886000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Economic burden of multiple sclerosis in Slovakia \u2014 from 2015 to 2020"],"prefix":"10.1186","volume":"22","author":[{"given":"Robert","family":"Babela","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judit","family":"Dugas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,12,2]]},"reference":[{"key":"8883_CR1","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1038\/s41572-018-0041-4","volume":"4","author":"M Filippi","year":"2018","unstructured":"Filippi M, Bar-Or A, Piehl F, Preziosa P, Solari A, Vukusic S, et al. Multiple sclerosis. Nat Rev Dis Primers. 2018;4:43.","journal-title":"Nat Rev Dis Primers"},{"key":"8883_CR2","doi-asserted-by":"publisher","first-page":"1622","DOI":"10.1016\/S0140-6736(18)30481-1","volume":"391","author":"AJ Thompson","year":"2018","unstructured":"Thompson AJ, Baranzini SE, Geurts J, Hemmer B, Ciccarelli O. Multiple sclerosis. Lancet. 2018;391:1622\u201336.","journal-title":"Lancet"},{"key":"8883_CR3","doi-asserted-by":"publisher","first-page":"e0198975","DOI":"10.1371\/journal.pone.0198975","volume":"13","author":"MW Enns","year":"2018","unstructured":"Enns MW, Bernstein CN, Kroeker K, Graff L, Walker JR, Lix LM, et al. The association of fatigue, pain, depression and anxiety with work and activity impairment in immune mediated inflammatory diseases. PLoS ONE. 2018;13:e0198975.","journal-title":"PLoS ONE"},{"key":"8883_CR4","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1016\/j.jval.2012.07.010","volume":"15","author":"BI Glanz","year":"2012","unstructured":"Glanz BI, D\u00e9gano IR, Rintell DJ, Chitnis T, Weiner HL, Healy BC. Work productivity in relapsing multiple sclerosis: associations with disability, depression, fatigue, anxiety, cognition, and health-related quality of life. Value Health. 2012;15:1029\u201335.","journal-title":"Value Health"},{"key":"8883_CR5","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1016\/j.dhjo.2015.02.006","volume":"8","author":"M Gavelova","year":"2015","unstructured":"Gavelova M, Nagyova I, Rosenberger J, Krokavcova M, Gdovinova Z, Groothoff JW, et al. Importance of an individual\u2019s evaluation of functional status for health-related quality of life in patients with multiple sclerosis. Disabil Health J. 2015;8:372\u20139.","journal-title":"Disabil Health J"},{"key":"8883_CR6","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1007\/978-3-319-47861-6_9","volume":"958","author":"D Bezzini","year":"2017","unstructured":"Bezzini D, Battaglia MA. Multiple sclerosis epidemiology in Europe. Adv Exp Med Biol. 2017;958:141\u201359.","journal-title":"Adv Exp Med Biol"},{"key":"8883_CR7","doi-asserted-by":"publisher","first-page":"1816","DOI":"10.1177\/1352458520970841","volume":"26","author":"C Walton","year":"2020","unstructured":"Walton C, King R, Rechtman L, Kaye W, Leray E, Marrie RA, et al. Rising prevalence of multiple sclerosis worldwide: insights from the Atlas of MS, third edition. Mult Scler. 2020;26:1816\u201321.","journal-title":"Mult Scler"},{"key":"8883_CR8","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1016\/S1474-4422(18)30499-X","volume":"18","author":"GBD 2016 Neurology Collaborators","year":"2019","unstructured":"GBD 2016 Neurology Collaborators. Global, regional, and national burden of neurological disorders, 1990\u20132016: a systematic analysis for the global burden of Disease Study 2016. Lancet Neurol. 2019;18:459\u201380.","journal-title":"Lancet Neurol"},{"key":"8883_CR9","unstructured":"European MSP. 2020 MS Barometer. Brussels: EMSP. Available from: https:\/\/www.emsp.org\/wp-content\/uploads\/2021\/03\/MS-Barometer2020-Final-Full-Report-Web.pdf Accessed 31 Mar 2022."},{"key":"8883_CR10","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1016\/j.ncl.2016.06.016","volume":"34","author":"J Howard","year":"2016","unstructured":"Howard J, Trevick S, Younger DS. Epidemiology of multiple sclerosis. Neurol Clin. 2016;34:919\u201339.","journal-title":"Neurol Clin"},{"key":"8883_CR11","first-page":"15","volume":"8","author":"L Vijayasingham","year":"2018","unstructured":"Vijayasingham L, Mairami FF. Employment of patients with multiple sclerosis: the influence of psychosocial-structural coping and context. Degener Neurol Neuromuscul Dis. 2018;8:15\u201324.","journal-title":"Degener Neurol Neuromuscul Dis"},{"key":"8883_CR12","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1186\/s12889-019-6907-x","volume":"19","author":"JM Garc\u00eda-Dom\u00ednguez","year":"2019","unstructured":"Garc\u00eda-Dom\u00ednguez JM, Maurino J, Mart\u00ednez-Gin\u00e9s ML, Carmona O, Caminero AB, Medrano N, et al. Economic burden of multiple sclerosis in a population with low physical disability. BMC Public Health. 2019;19:609.","journal-title":"BMC Public Health"},{"key":"8883_CR13","first-page":"17","volume":"21","author":"RT Roessler","year":"2003","unstructured":"Roessler RT, Rumrill PD Jr. Multiple sclerosis and employment barriers: a systemic perspective on diagnosis and intervention. Work. 2003;21:17\u201323.","journal-title":"Work"},{"key":"8883_CR14","doi-asserted-by":"publisher","first-page":"102162","DOI":"10.1016\/j.msard.2020.102162","volume":"43","author":"M Paz-Zulueta","year":"2020","unstructured":"Paz-Zulueta M, Par\u00e1s-Bravo P, Cantarero-Prieto D, Bl\u00e1zquez-Fern\u00e1ndez C, Oterino-Dur\u00e1n A. A literature review of cost-of-illness studies on the economic burden of multiple sclerosis. Mult Scler Relat Disord. 2020;43:102162.","journal-title":"Mult Scler Relat Disord"},{"key":"8883_CR15","doi-asserted-by":"publisher","first-page":"e0159129","DOI":"10.1371\/journal.pone.0159129","volume":"11","author":"O Ernstsson","year":"2016","unstructured":"Ernstsson O, Gyllensten H, Alexanderson K, Tingh\u00f6g P, Friberg E, Norlund A. Cost of illness of multiple sclerosis \u2013 a systematic review. PLoS One. 2016;11:e0159129.","journal-title":"PLoS One"},{"key":"8883_CR16","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.1177\/1352458517737388","volume":"24","author":"M Tinelli","year":"2018","unstructured":"Tinelli M, Kanavos P, Efthymiadou O, Visintin E, Grimaccia F, Mossman J. Using IMPrESS to guide policy change in multiple sclerosis. Mult Scler. 2018;24:1251\u201355.","journal-title":"Mult Scler"},{"key":"8883_CR17","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1177\/1352458517694432","volume":"23","author":"G Kobelt","year":"2017","unstructured":"Kobelt G, Thompson A, Berg J, Gannedahl M, Eriksson J. New insights into the burden and costs of multiple sclerosis in Europe. Mult Scler. 2017;23:1123\u201336.","journal-title":"Mult Scler"},{"issue":"Suppl 2","key":"8883_CR18","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1177\/1352458517708176","volume":"23","author":"M Battaglia","year":"2017","unstructured":"Battaglia M, Kobelt G, Ponzio M, Berg J, Capsa D, Dal\u00e9n J. New insights into the burden and costs of multiple sclerosis in Europe: results for Italy. Mult Scler. 2017;23(Suppl 2):104\u201316.","journal-title":"Mult Scler"},{"issue":"Suppl 2","key":"8883_CR19","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1177\/1352458517708099","volume":"23","author":"T Berger","year":"2017","unstructured":"Berger T, Kobelt G, Berg J, Capsa D, Gannedahl M. New insights into the burden and costs of multiple sclerosis in Europe: results for Austria. Mult Scler. 2017;23(Suppl 2):17\u201328.","journal-title":"Mult Scler"},{"issue":"Suppl 2","key":"8883_CR20","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1177\/1352458517708100","volume":"23","author":"B Dubois","year":"2017","unstructured":"Dubois B, Kobelt G, Berg J, Capsa D, Gannedahl M. New insights into the burden and costs of multiple sclerosis in Europe: results for Belgium. Mult Scler. 2017;23(Suppl 2):29\u201340.","journal-title":"Mult Scler"},{"issue":"Suppl 2","key":"8883_CR21","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1177\/1352458517708672","volume":"23","author":"C Oreja-Guevara","year":"2017","unstructured":"Oreja-Guevara C, Kobelt G, Berg J, Capsa D, Eriksson J. New insights into the burden and costs of multiple sclerosis in Europe: results for Spain. Mult Scler. 2017;23(Suppl 2):166\u201378.","journal-title":"Mult Scler"},{"issue":"Suppl 2","key":"8883_CR22","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1177\/1352458517708663","volume":"23","author":"B Uitdehaag","year":"2017","unstructured":"Uitdehaag B, Kobelt G, Berg J, Capsa D, Dal\u00e9n J. New insights into the burden and costs of multiple sclerosis in Europe: results for the Netherlands. Mult Scler. 2017;23(Suppl 2):117\u201329.","journal-title":"Mult Scler"},{"issue":"Suppl 2","key":"8883_CR23","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1177\/1352458517708142","volume":"23","author":"M P\u00e9ntek","year":"2017","unstructured":"P\u00e9ntek M, Kobelt G, Berg J, Capsa D, Dal\u00e9n J, B\u00edr\u00f3 Z, et al. New insights into the burden and costs of multiple sclerosis in Europe: results for Hungary. Mult Scler. 2017;23(Suppl 2):91\u2013103.","journal-title":"Mult Scler"},{"issue":"Suppl 2","key":"8883_CR24","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1177\/1352458517708682","volume":"23","author":"L Brundin","year":"2017","unstructured":"Brundin L, Kobelt G, Berg J, Capsa D, Eriksson J. New insights into the burden and costs of multiple sclerosis in Europe: results for Sweden. Mult Scler. 2017;23(Suppl 2):179\u201391.","journal-title":"Mult Scler"},{"issue":"Suppl 2","key":"8883_CR25","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1177\/1352458517708685","volume":"23","author":"P Calabrese","year":"2017","unstructured":"Calabrese P, Kobelt G, Berg J, Capsa D, Eriksson J. New insights into the burden and costs of multiple sclerosis in Europe: results for Switzerland. Mult Scler. 2017;23(Suppl 2):192\u2013203.","journal-title":"Mult Scler"},{"issue":"Suppl 2","key":"8883_CR26","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1177\/1352458517708141","volume":"23","author":"P Flachenecker","year":"2017","unstructured":"Flachenecker P, Kobelt G, Berg J, Capsa D, Gannedahl M. New insights into the burden and costs of multiple sclerosis in Europe: results for Germany. Mult Scler. 2017;23(Suppl 2):78\u201390.","journal-title":"Mult Scler"},{"key":"8883_CR27","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1177\/1352458517708118","volume":"Suppl 2","author":"PV Rasmussen","year":"2017","unstructured":"Rasmussen PV, Kobelt G, Berg J, Capsa D, Gannedahl M. New insights into the burden and costs of multiple sclerosis in Europe: results for Denmark. Mult Scler. 2017;Suppl 2:53\u201364.","journal-title":"Mult Scler"},{"issue":"Suppl 2","key":"8883_CR28","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1177\/1352458517708125","volume":"23","author":"C Lebrun-Frenay","year":"2017","unstructured":"Lebrun-Frenay C, Kobelt G, Berg J, Capsa D, Gannedahl M. New insights into the burden and costs of multiple sclerosis in Europe: results for France. Mult Scler. 2017;23(Suppl 2):65\u201377.","journal-title":"Mult Scler"},{"issue":"Suppl 2","key":"8883_CR29","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1177\/1352458517708687","volume":"23","author":"A Thompson","year":"2017","unstructured":"Thompson A, Kobelt G, Berg J, Capsa D, Eriksson J, Miller D. New insights into the burden and costs of multiple sclerosis in Europe: results for the United Kingdom. Mult Scler. 2017;23(Suppl 2):204\u201316.","journal-title":"Mult Scler"},{"issue":"Suppl 2","key":"8883_CR30","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1177\/1352458517708666","volume":"23","author":"K Selmaj","year":"2017","unstructured":"Selmaj K, Kobelt G, Berg J, Orlewska E, Capsa D, Dal\u00e9n J. New insights into the burden and costs of multiple sclerosis in Europe: results for Poland. Mult Scler. 2017;23(Suppl 2):130\u201342.","journal-title":"Mult Scler"},{"issue":"Suppl 2","key":"8883_CR31","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1177\/1352458517708117","volume":"23","author":"E Havrdova","year":"2017","unstructured":"Havrdova E, Kobelt G, Berg J, Capsa D, Gannedahl M, Dole\u017eal T. New insights into the burden and costs of multiple sclerosis in Europe: results of the Czech Republic. Mult Scler. 2017;23(Suppl 2):41\u201352.","journal-title":"Mult Scler"},{"key":"8883_CR32","unstructured":"Atlas multiple sclerosis resources in the world. 2008. Available from: https:\/\/www.who.int\/mental_health\/neurology\/Atlas_MS_WEB.pdf Accessed 31 Mar 2022."},{"key":"8883_CR33","unstructured":"Multiple sclerosis in Europe. Available from: https:\/\/www.emsp.org\/wp-content\/uploads\/2015\/08\/MS-in-EU-access.pdf Accessed 31 Mar 2022."},{"key":"8883_CR34","doi-asserted-by":"publisher","DOI":"10.12955\/emhpj.v3i0.346","author":"M P\u0161enkov\u00e1","year":"2012","unstructured":"P\u0161enkov\u00e1 M, Mackovi\u010dov\u00e1 S, Pal\u00fach A, Folt\u00e1nov\u00e1 T, Petrov\u00e1 L. Economic burden of multiple sclerosis in Slovakia. Eur Med Health Pharm J. 2012. https:\/\/doi.org\/10.12955\/emhpj.v3i0.346.","journal-title":"Eur Med Health Pharm J"},{"key":"8883_CR35","unstructured":"V\u00fdvoj po\u010dtu poistencov V\u0161ZP. 2020. [Online]. Available from: https:\/\/www.vszp.sk\/showdoc.do?docid=2219&forceBrowserDetector=blind. Accessed 21 Jan 2021."},{"key":"8883_CR36","doi-asserted-by":"publisher","first-page":"953","DOI":"10.3389\/fneur.2019.00953","volume":"10","author":"M Kaufmann","year":"2019","unstructured":"Kaufmann M, Puhan MA, Kuhle J, Yaldizli \u00d6, Magnusson T, Kamm CP. at al. A framework for estimating the burden of chronic diseases: design and application in the context of multiple sclerosis. Front Neurol. 2019;10:953.","journal-title":"Front Neurol"},{"key":"8883_CR37","doi-asserted-by":"publisher","first-page":"936","DOI":"10.3109\/09638288.2015.1070295","volume":"38","author":"A Raggi","year":"2016","unstructured":"Raggi A, Covelli V, Schiavolin S, Scaratti C, Leonardi M, Willems M. Work-related problems in multiple sclerosis: a literature review on its associates and determinants. Disabil Rehabil. 2016;38:936\u201344.","journal-title":"Disabil Rehabil"},{"key":"8883_CR38","doi-asserted-by":"publisher","first-page":"5127","DOI":"10.1007\/s00415-022-11169-w","volume":"269","author":"MA Battaglia","year":"2022","unstructured":"Battaglia MA, Bezzini D, Cecchini I, et al. Patients with multiple sclerosis: a burden and cost of illness study. J Neurol. 2022;269:5127\u201335. https:\/\/doi.org\/10.1007\/s00415-022-11169-w.","journal-title":"J Neurol"},{"key":"8883_CR39","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1111\/j.1468-1331.2011.03590.x","volume":"19","author":"J Olesen","year":"2012","unstructured":"Olesen J, Gustavsson A, Svensson M, Wittchen HU, J\u00f6nsson B. The economic cost of brain disorders in Europe. Eur J Neurol. 2012;19:155\u201362.","journal-title":"Eur J Neurol"},{"key":"8883_CR40","doi-asserted-by":"publisher","first-page":"2345","DOI":"10.1007\/s00415-017-8632-7","volume":"264","author":"R Wynford-Thomas","year":"2017","unstructured":"Wynford-Thomas R, Robertson NP. The economic burden of chronic neurological disease. J Neurol. 2017;264:2345\u20137.","journal-title":"J Neurol"},{"key":"8883_CR41","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1586\/14737167.2015.1067141","volume":"15","author":"E Stawowczyk","year":"2015","unstructured":"Stawowczyk E, Malinowski KP, Kawalec P, Mo\u0107ko P. The indirect costs of multiple sclerosis: systematic review and meta-analysis. Expert Rev Pharmacoecon Outcomes Res. 2015;15:759\u201386.","journal-title":"Expert Rev Pharmacoecon Outcomes Res"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-022-08883-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-022-08883-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-022-08883-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T08:33:40Z","timestamp":1669970020000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-022-08883-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,2]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["8883"],"URL":"https:\/\/doi.org\/10.1186\/s12913-022-08883-6","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,2]]},"assertion":[{"value":"16 May 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 November 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 December 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"We confirm that our research did not involve human participants or human material, only aggregated human data. No personally identifiable data were obtained or used. We confirm that all methods were carried out in accordance with relevant guidelines and regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical guidelines"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1467"}}