Home based management in multiple sclerosis: results of a randomised controlled trial.
BACKGROUND
Home based medical care is a popular alternative to standard hospital care but there is uncertainty about its cost-effectiveness.


OBJECTIVE
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 < or = 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.
Dipartimento di Scienze Neurologiche, Università "La Sapienza", Rome, Italy. carlo.pozzilli@uniroma1.it
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Brunetti
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Gasperini
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Ristori
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Battaglia
D000328:Adult; D003362:Cost-Benefit Analysis; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D018575:Home Care Services, Hospital-Based / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000191:economics* / Q000534:rehabilitation; D010348:Patient Care Team