This study investigated the effects of relapses and levels of disability on resource use in a multidisciplinary MS clinic. Data were collected over a 12-month period on the number of clinic visits, relapse rate, use of disease modifying therapies (DMTs), use of the multidisciplinary team, and treatment of individual symptoms. 41/427 patients had a relapse. Relapsing patients had lower levels of disability but had more clinic visits (mean 4.63 vs 2.79, p<0.001), and were more likely to see the specialist nurse (82% vs 62% p=0.019), physiotherapist (65.9% vs 46.1%, p=0.021) and orthoptist (41.5% vs 22.3% p=0.001). Relapsing patients were more likely to receive DMTs (49% vs 14%, p<0.001). In order to investigate the effects of higher levels of disability, 107 ambulatory patients with progressive MS and an EDSS of <=6.5 were compared with 105 non-ambulatory patients with an EDSS of >=7.0. The more disabled group were more likely to see the speech therapist (14.3 % vs 3.7%, p=0.007) and had a lower rate of fatigue (52.3% vs 22.9%, p=0.001). This study shows that relapses are a greater driver of resource use than the overall level of disability. Thus the beneficial effect of DMTs in reducing relapse frequency will play an important role in reducing cost of care. Very few differences in rates of symptom treatment were found between patients with different levels of disability and relapse rates. This data supports the use of multidisciplinary clinics in all phases of MS.
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