J Neurol Neurosurg Psychiatry 2002 Sep;73(3):250-5
Pozzilli C, Brunetti M, Amicosante AM, Gasperini C, Ristori G, Palmisano L, Battaglia M.
Dipartimento di Scienze Neurologiche, Universita "La Sapienza", Rome, Italy Istituto di Ricerche Farmacologiche "Mario Negri", Milan Dipartimento di Neurologia, Ospedale San Camillo-Forlanini, Rome Fondazione Italiana Sclerosi Multipla, Rome.
Home based medical care is a popular alternative to standard hospital care but there is uncertainty about its cost-effectiveness.
To compare the effectiveness and the costs of multidisciplinary home based care in multiple sclerosis with hospital care in a prospective randomised controlled trial with a one year follow up.
201 patients with clinically definite multiple sclerosis were studied. They were randomised in a ratio 2:1 to an intervention group (133) or a control group (68). They were assessed at baseline and one year after randomisation with validated measures of physical and psychological impairment and quality of life (SF-36 health survey). The costs to the National Health Service over the one year follow up were calculated by a cost minimisation analysis.
There were no differences in functional status between the home based care group and the hospital group. There was a significant difference between the two groups favouring home based management in four SF-36 health dimensions-general health, bodily pain, role-emotional, and social functioning (all p </= 0.001). The cost of home based care was slightly less (822 euros/patient/year) than hospital care, mainly as a result of a reduction in hospital admissions.
Comprehensive planning of home based intervention implemented by an interdisciplinary team and designed specifically for people with multiple sclerosis may provide a cost-effective approach to management and improve the quality of life.