title: Socioeconomic trends in hospitalization for multiple sclerosis.
abstract: OBJECTIVE
  Multiple sclerosis (MS) is a neurological disorder with a high burden on patient quality of life and medical rehabilitation services. Little is known about the acute hospitalization costs and characteristics. We examined the trends in MS hospitalizations from 1993 to 2006.
  
  
  METHODS
  The Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project was searched using the ICD-9 code 340 (MS). Diagnostic, treatment and administrative data were analyzed using basic statistical software.
  
  
  RESULTS
  A total of 288,454 hospital admissions with the primary diagnosis of MS occurred between 1993 and 2006, an average of 20,604 admissions annually. The percentage admitted from the emergency department (ED) increased from 19.4 to 60.0% during 1993-2006. The mean cost for each inpatient increased from USD 7,965 to 20,076. The percentage of discharges to home health care increased from 8.6 to 14.9%, and the percentage of discharges to nursing homes and rehabilitation services increased from 8.3 to 22.6%. In 2006, Medicaid patients were significantly more likely to be admitted from the ED (p < 0.001). Medicare payers were significantly more likely to be discharged to a nursing home/rehabilitation (p < 0.0001).
  
  
  CONCLUSIONS
  National health insurance policies have made measurable effects on MS disease management. MS is becoming more expensive to treat acutely, and improved treatment modalities geared toward decreasing acute flare-ups may provide substantial cost savings by reducing ED visits, inpatient hospitalizations and the need for rehabilitation.
authors.affiliation: Outcomes Research Laboratory, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA. nlad@stanford.edu
authors.forename: Shivanand P
authors.initials: SP
authors.lastname: Lad
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Chapman
authors.forename: Michael
authors.initials: M
authors.lastname: Vaninetti
authors.forename: Lawrence
authors.initials: L
authors.lastname: Steinman
authors.forename: Ari
authors.initials: A
authors.lastname: Green
authors.forename: Maxwell
authors.initials: M
authors.lastname: Boakye
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D003710:Demography; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult