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Pract."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Neuromyelitis optica spectrum disorders (NMOSD) are associated with a high burden of depression, pain, and physical disability, all of which significantly impair quality of life. At the same time, discussions on the cost-effectiveness of treatment strategies are gaining importance. However, it is not yet known whether specific symptom burdens are particularly cost-driving. This study aims to provide a comprehensive cost analysis considering depression and pain to optimise future healthcare strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective cross-sectional multicentre study was conducted at twelve centres of the Neuromyelitis Optica Study Group (NEMOS). Over a three-year period, 115 NMOSD patients were recruited. Disease-related costs, pain, and depression were assessed using standardised questionnaires. A generalised linear model analysis and graphical sub-cost analysis were performed to identify key cost drivers. The robustness of our findings was confirmed using two independent depression rating scales.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In our sample of 115 patients, 77% suffered from chronic pain with a median pain intensity of 4.0 on the numeric rating scale (NRS). Moreover, 56% of patients reported depressive symptoms. In multivariate regression analysis, depression emerged as a significant predictor of total costs (p\u2009&lt;\u20090.001) alongside the EDSS score (p\u2009&lt;\u20090.001) and age (p\u2009=\u20090.004). In contrast, pain was not significantly influencing total costs (p\u2009=\u20090.057), despite being reported by the majority of patients. Graphical analyses highlighted informal costs as the main cost driver in patients with increasing depressive symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Depressive symptoms are not only common in NMOSD patients but also represent a major cost driver alongside neurological disability. Addressing these symptoms is essential for optimal patient care and may help reduce the socioeconomic burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42466-026-00486-4","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T12:21:15Z","timestamp":1777897275000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Socioeconomic impact of depression and pain in patients with neuromyelitis optica spectrum disorders"],"prefix":"10.1186","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5647-8038","authenticated-orcid":false,"given":"Daria","family":"Tkachenko","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilya","family":"Ayzenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louisa 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No individually identifiable patient information is presented in this manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"DT was supported by PRACTIS Clinician Scientist Program, funded by Hannover Medical School and DFG (DFG ME 3696\/3). IA has received speaking honoraria and scientifc advisory board compensation from Alexion, Roche, Argenx, Merck Serono, Amgen and Sanofi Genzyme and research support from Roche, Diamed and Alexion. RS was supported by PRACTIS Clinician Scientist Program, funded by Hannover Medical School and DFG (DFG ME 3696\/3) and took part in an educational event sponsored by Livanova, manufacturer of vagus nerve stimulation devices. FP has received honoraria and research support from Alexion, Bayer, Biogen, Chugai, MerckSerono, Novartis, Genyzme, Horizon\/ MedImmune, Shire, Teva, and serves on scientific advisory boards for Alexion, MedImmune and Novartis. He has received funding from Deutsche Forschungsgemeinschaft (DFG Exc 257), Bundesministerium f\u00fcr Bildung und Forschung (Competence Network Multiple Sclerosis), Guthy Jackson Charitable Foundation, EU Framework Program 7, National Multiple Sclerosis Society of the USA. JBS has received institutional research support from NEMOS e.V., Alexion and Bayer AG, a scholarship award from Stiftung Charit\u00e9 (Clinical Fellow Program), personal compensation from Alexion, speaking honoraria and travel grants from Bayer Healthcare, Horizon\/Amgen, Novartis and sanofi-aventis\/Genzyme, in addition received compensation for serving on a scientific advisory board of Alexion, Roche and Merck, all unrelated to the presented work. NS has received speaker honoraria from Teva GmbH, Alexion Pharma Germany GmbH and Roche Pharma AG. TK has received personal fees for advisory boards from Alexion\/Astra Zeneca, UCB, Merck and Biogen and for speaker honoraria\/chairs and\/or lectures\/education from Alexion\/Astra Zeneca, Novartis Pharma, Roche Pharma,, Horizon Therapeutics\/Amgen, Chugai Pharma. The Institution she works for has received compensation for serving as a member of a steering committee from Roche. JH reports a grant for OCT research from the Friedrich\u2010Baur\u2010Stiftung, Horizon, and Merck; personal fees and nonfinancial support from Alexion, Amgen, Biogen, Merck, Novartis, and Roche; and nonfinancial support from the Sumaira\u2010Foundation and Guthy\u2010Jackson Charitable Foundation, all outside the submitted work. HP received honoraria for lectures from Bayer Health Care, Biogen Idec, and Teva Pharma and travel reimbursement from Novartis. BW has received grants from the German Ministry of Education and Research, Deutsche Forschungsgemein schaft, Dietmar Hopp Stiftung, Klaus Tschira Stiftung, and Merck, and personal fees from Alexion, Bayer, Biogen, Roche. AB receives funding from the Innovationsausschuss of the German Federal Joint Committee (G-BA; grant 01VSF23040) and from the German Federal Ministry of Research, Technology and Space (BMFTR; grant 01ZZ2505A). He has received consulting and\/or speaker fees from Alexion, Argenx, Biogen, CSL Behring, Horizon\/Amgen, Merck, Neuraxpharm, Novartis, and Roche, and his institution has received compensation for clinical trials from Ad Scientiam, Alexion, Biogen, Merck, Novartis, Roche, and Sanofi Genzyme; all outside the present work. LK received compensation for serving on Scientific Advisory Boards for Alexion, Biogen, Bristol-Myers Squibb, Hexal, Horizon, Janssen, Merck Serono, Novartis, Roche, Sandoz, Sanofi, Teva and Viatris. She received speaker honoraria and travel support from Amgen, Argenx, Bayer, Biogen, Bristol-Myers Squibb, Grifols, Horizon, Merck Serono, Novartis, Roche, Sanofi, Santhera and Teva. She receives research support from the German Research Foundation, the IZKF M\u00fcnster, Merck Serono, Novartis, Roche and Sanofi. MP declares that there are no conflicts of interest in connection with this study, he has received honoraria for lectures or consultancy work from ArgenX, Alexion, Bayer, Biogen, Diamed, Hexal, Janssen, Merck, Novartis, Roche, Sanofi, Takeda, TEVA, travel expenses to attend meetings from Biogen, Merck and Sanofi and research support from Amgen, Argenx, Biogen, Hexal, Merck, Roche, DMSG NRW, Viatris, BMBF, Braun-Stiftung. SG reports research support from Alnylam Pharmaceuticals, CSL Behring, Else Kr\u00f6ner Fresenius Foundation, Deutsche Forschungsgemeinschaft and Hannover Biomedical Research School (HBRS) and consulting and\/or speaker honoraria from Alexion, Alnylam Pharmaceuticals, AstraZeneca, CSL Behring, GSK, Pfizer, Merck and Takeda Pharmaceuticals all outside the submitted work. MS has received consulting and\/or speaker honoraria from Alexion, Bayer, Biogen, Bristol-Myers-Squibb, Merck, Roche, and Sanofi Genzyme. She has received research funding from the Hertha-Nathorff-Program. VH has received funding from NEMOS e.V. independent of this project. OA reports grants from the German Ministry of Education and Research (BMBF) and the German Research Foundation (DFG); personal fees and travel support from Alexion, Almirall, Amgen, Biogen, Janssen, Novartis, Roche, Sanofi, and UCB. MR received speaker honoraria from Novartis, Bayer Vital GmbH, Roche, Alexion, Horizon\/Amgen and Ipsen and travel reimbursement from Bayer Schering, Biogen Idec, Merz, Genzyme, Teva, Roche, Alexion, Horizon\/Amgen and Merck, none related to this study. KH has received personal compensation for speaking with Alexion and Roche. CS has received speaker honoraria from Alexion, Roche and travel support from Novartis, UCB, all not related to the content of this manuscript; as well as research support from FORUM (clinician scientist position), medical faculty Ruhr-Universit\u00e4t Bochum. IK has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Alexion, Biogen, GlaxoSmithKline, Hexal, Juvis\u00e9 Pharmaceuticals, Merck, Neuraxpharm, Roche\/Chugai and Sanofi. CT received honoraria for consultation and expert testimony from\u00a0Alexion Pharma Germany GmbH. None of this interfered with the current report. MWH received institutional research support from Myelitis e. V., German Federal Joint Committee\/Innovation Fund, and NEMOS e. V.. Speaker honoraria from selpers og, AMGEN\/Horizon, and Alexion, travel grants from Alexion and compensation for serving on an advisory board from Alexion, Roche and UCB. None of this interfered with the current manuscript. The remaining authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"36"}}