Multiple sclerosis (MS) experts in Europe are facing rapidly rising demands of excellence due to the increasing complexity of MS therapy and management. A central European expert board of MS experts met to identify needs and obstacles with respect to raising quality of MS care in central and Eastern European countries. There are substantial variations across countries regarding delivery of care and its cost structure, as well as access to treatment. To date, Eastern European countries are often less able to afford reimbursement of immunomodulatory agents than Western countries. Overall, approximately 40% of working-age patients are not working due to MS. Costs rise steeply with increasing disability; indirect costs constitute the bulk of the financial burden in patients with severe MS. Magnetic resonance imaging (MRI) assessment is meanwhile obligatory as the diagnostic interface in the management of MS patients. Recommended measures directed at improving quality of care include the collection of patient data in registries, enhanced education of healthcare professionals, implementation of national strategies aiming at reducing regional variation, optimization of approval processes, and removal of administrative barriers. Local partnerships with authorities such as those that represent the interests of employees can contribute to leverage the importance of epidemiological data. The need for education extends to (neuro)radiologists who are responsible for reporting MRI findings in expert quality. Dissemination of the Magnetic Resonance Imaging in MS (MAGNIMS) protocol would be an important step in this context. Also, clinical freedom of choice is rated as essential. Physicians should have access to a range of treatment options due to the complexity of disease. Guidelines such as the upcoming EAN-ECTRIMS clinical practice guideline also aim at providing a basis for argumentation in negotiations with national health authorities.

Clinical Department of Neurology Medical University of Innsbruck Anichstrasse 35 A 6020 Innsbruck Austria

Department of Neurology and Center of Clinical Neuroscience 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Neurology and MTA SZTE Neuroscience Research Group University of Szeged Szeged Hungary

Department of Neurology Comenius University Bratislava Slovakia

Department of Neurology Faculty of Medicine University of Debrecen Debrecen Hungary

Department of Neurology in Zabrze Medical University of Silesia Katowice Poland

Department of Neurology Jahn Ferenc Dél pesti Hospital Budapest Hungary

Department of Neurology Medical University of Graz Graz Austria

Department of Neurology Medical University of Lublin Lublin Poland

Department of Neurology Medical University of Vienna Vienna Austria

Department of Neurology Pavol Jozef Šafárik University and University Hospital L Pasteur Košice Slovakia

Department of Neurology University Medical Centre Maribor Maribor Slovenia

Department of Neurology University of Ljubljana Ljubljana Slovenia

Department of Neurology University of Prešov and Teaching Hospital of JA Reiman Prešov Slovakia

Department of Neurology University of Southern Denmark Odense Denmark

MS Centrum Teplice Teplice Czech Republic

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Factors influencing daily treatment choices in multiple sclerosis: practice guidelines, biomarkers and burden of disease