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Home based management in multiple sclerosis: results of a randomised controlled trial
  1. C Pozzilli1,
  2. M Brunetti2,
  3. A M V Amicosante2,
  4. C Gasperini3,
  5. G Ristori1,
  6. L Palmisano4,
  7. M Battaglia4
  1. 1Dipartimento di Scienze Neurologiche, Università “La Sapienza”, Rome, Italy
  2. 2Istituto di Ricerche Farmacologiche “Mario Negri”, Milan
  3. 3Dipartimento di Neurologia, Ospedale San Camillo-Forlanini, Rome
  4. 4Fondazione Italiana Sclerosi Multipla, Rome
  1. Correspondence to:
 Dr C Pozzilli, Dipartimento di Scienze Neurologiche, Università “La Sapienza”, Viale dell'Università 30, 00185 Rome, Italy;
 carlo.pozzilli{at}uniroma1.it

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.

  • home based management
  • multiple sclerosis
  • quality of life
  • costs
  • 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

https://doi.org/10.1136/jnnp.73.3.250

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    Footnotes

    • Competing interests: none declared.