Cost of managing an episode of relapse in multiple sclerosis in the United States.
BACKGROUND
The purpose of this study was to determine the direct medical US cost of managing multiple sclerosis relapses.


METHODS
Direct data analysis and cost modeling were employed to derive typical resource use profiles and costs in 2002 US dollars, from the perspective of a third-party payer responsible for comprehensive health-care. The location and scope of health care services provided over a 90-day period were used to define three levels of relapse management. Hospitalization and resulting subsequent care was defined as high intensity management. A medium level of intervention was defined as either use of the emergency room, an observational unit, or administration of acute treatments, such as intravenous methylprednisolone in an outpatient or home setting. The lowest intensity of care comprised physician office visits and symptom-related medications. Data were obtained from many sources including all payer inpatient, ambulatory and emergency room databases from several states, fee schedules, government reports, and literature. All charges were adjusted using cost-to-charge ratios.


RESULTS
Average cost per person for high management level was 12,870 dollars, based on analysis of 4,634 hospital cases (mean age 48 years, 73% female). Hospital care comprised 71% of that cost. At discharge, 36% required inpatient sub-acute care, rehabilitation or home care. The typical cost per moderate episode was 1,847 dollars and mild episode 243 dollars.


CONCLUSIONS
Management strategies leading to a reduction in the frequency and severity of a relapse, less reliance on inpatient care, or increased access to steroid infusions in the home, would have a substantial impact on the economic consequences of managing relapses.
O'Brien
Judith A
JA
Caro Research Institute, Concord, MA 01742, USA. jobrien@caroresearch.com
Ward
Alexandra J
AJ
Patrick
Amanda R
AR
Caro
Jaime
J
D000328:Adult; D000359:Aftercare / Q000191:economics; D000553:Ambulatory Care / Q000191:economics; D017281:Cost of Illness; D004180:Direct Service Costs / Q000706:statistics & numerical data*; D016527:Drug Costs / Q000706:statistics & numerical data; D017050:Episode of Care; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D008775:Methylprednisolone / Q000191:economics / Q000627:therapeutic use; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000191:economics* / Q000517:prevention & control*; D012008:Recurrence; D014481:United States
D008775:Methylprednisolone