Home based management in multiple sclerosis: results of a randomised controlled trial
- 1Dipartimento di Scienze Neurologiche, Università “La Sapienza”, Rome, Italy
- 2Istituto di Ricerche Farmacologiche “Mario Negri”, Milan
- 3Dipartimento di Neurologia, Ospedale San Camillo-Forlanini, Rome
- 4Fondazione Italiana Sclerosi Multipla, Rome
- Correspondence to: Dr C Pozzilli, Dipartimento di Scienze Neurologiche, Università “La Sapienza”, Viale dell'Università 30, 00185 Rome, Italy; carlo.pozzilli{at}uniroma1.it
- Received 15 January 2002
- Accepted 20 May 2002
- Revised 16 May 2002
Abstract
Background: Home based medical care is a popular alternative to standard hospital care but there is uncertainty about its cost-effectiveness.
Objectives: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
- CDQ, clinical depression questionnaire
- EDSS, expanded disability status score
- FIM, functional independence measure
- FSS, fatigue severity scale
- MCS, mental component score
- MMSE, mini-mental state examination
- PCS, physical component score
- SF-36, 36 item short form health survey questionnaire
- STAI, state trait anxiety inventory
- STAXI, state trait anger expression inventory
Footnotes
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Competing interests: none declared.
