title: Prospective study of cost of care at multidisciplinary ALS centers adhering to American Academy of Neurology (AAN) ALS practice parameters.
abstract: Multidisciplinary care in ALS is associated with longer survival, improved quality of life, and reduced hospital admissions, but there are no published data on institutional costs associated with multidisciplinary ALS care at U.S. centers. We prospectively examined institutional costs, adherence to AAN Practice Parameters and patient satisfaction in multidisciplinary ALS clinics at 18 U.S. ALS centers. Centers reported patient volumes; direct costs for staff salary/benefits, supplies and equipment; and institutional non-salary and overhead costs over a three-month period. In 1117 patients seen during this period, mean age was 61.5 years (range 25-91 years), 56% were male, and mean ALSFRS-R score was 29. Mean total salary/benefit cost per clinic day for all providers was $2964 (range $1692-$5236 across centers). Mean salary/benefit cost per patient per clinic was $507 (range $258-$806 across centers). Differences among centers in reporting non-salary costs prevented meaningful analysis. Practice parameter adherence and patient satisfaction were high. This prospective collaborative study demonstrates the direct financial burden of evidence-based multidisciplinary ALS care in the U.S.; more refined non-salary and overhead cost data are needed to evaluate the full cost impact of care. These data may be useful in supporting evidence-based models of patient centered care for ALS.
authors.affiliation: a Department of Neurology , Mayo Clinic , Jacksonville , Florida.
authors.forename: Kevin
authors.initials: K
authors.lastname: Boylan
authors.affiliation: b Phoenix Neurological Institute , Phoenix , Arizona.
authors.forename: Todd
authors.initials: T
authors.lastname: Levine
authors.affiliation: c Department of Neurology , University of California San Francisco , San Francisco , California.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lomen-Hoerth
authors.affiliation: d The ALS Association , Washington DC.
authors.forename: Mary
authors.initials: M
authors.lastname: Lyon
authors.affiliation: d The ALS Association , Washington DC.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Maginnis
authors.affiliation: e Department of Medical Biostatistics , University of Vermont College of Medicine , Burlington , Vermont.
authors.forename: Peter
authors.initials: P
authors.lastname: Callas
authors.affiliation: f University of Vermont Medical Center , Burlington , Vermont.
authors.forename: Celeste
authors.initials: C
authors.lastname: Gaspari
authors.affiliation: g Department of Neurological Sciences , University of Vermont College of Medicine and University of Vermont Medical Center , Burlington , Vermont , USA.
authors.forename: Rup
authors.initials: R
authors.lastname: Tandan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000191:economics* / Q000706:statistics & numerical data; D000690:Amyotrophic Lateral Sclerosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D019983:Guideline Adherence / Q000191:economics* / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000191:economics / Q000592:standards*; D010348:Patient Care Team; D017060:Patient Satisfaction / Q000191:economics / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists
keywords: Amyotrophic lateral sclerosis; health care economics; multidisciplinary care