Specialist Inpatient Rehabilitation Cost-effective for MS Patients in UK, Particularly in Advanced Disease

Specialist inpatient rehabilitation is a cost-effective strategy that can improve the clinical outcomes of patients with multiple sclerosis (MS), particularly those at more advanced stages of the disease, a study in the United Kingdom (U.K.) found.

The study, “Cost-efficiency of specialist inpatient rehabilitation for adults with multiple sclerosis: A multicentre prospective cohort analysis of the UK Rehabilitation Outcomes Collaborative national clinical dataset for rehabilitation centres in England,” was published in the Multiple Sclerosis Journal – Experimental, Translational and Clinical.

MS is a neurodegenerative and autoimmune disease that affects the central nervous system (consisting of the brain and spinal cord). It can cause physical, cognitive, and mental deficits that reduce the autonomy and quality of life of those with the disease.

A growing body of evidence supports the effectiveness of rehabilitation at improving the clinical outcomes of those with MS.

“By improving independence and autonomy, rehabilitation has the potential to reduce the burden and costs of care, both for family and society,” researchers wrote. “Specialist rehabilitation is increasingly recognized as an essential component of healthcare for this group of patients, but it can be a costly intervention and systematic evaluation is required to demonstrate that [programs] are both effective and cost-efficient.”

To evaluate the functional outcomes, care needs, and cost-efficiency of specialist inpatient rehabilitation for adults with MS, investigators at King’s College London conducted a large group study based on data from the U.K. Rehabilitation Outcomes Collaborative (ROC) national database.

The study included data from 1,007 MS patients (63% women, with a mean age of 51.7 years at admission) who were admitted to specialist inpatient rehabilitation in England from 2010 to 2018.

The Northwick Park Dependency Scale (NPDS) was used to evaluate patients’ dependency on nursing staff, and the Northwick Park Care Needs Assessment (NPCNA) to estimate the number of care hours and total costs per week. The U.K. Functional Assessment Measure was used to assess patients’ disability.

For the analysis, investigators divided patients into three groups, based on their level of dependency: the low dependency group included those who did not require assistance to perform basic self-care tasks (NPDS scores lower than 10); the intermediate dependency group included those who required help from another person to perform most self-care tasks (NPDS scores 10–24); and the high dependency group included those who needed help from two or more people for most tasks and often had special nursing requirements (NPDS scores of 25 or higher).

Patients in the low dependency group were younger (by a mean of six to eight  years) than those in the other two groups, and were at an earlier stage of MS at admission.

The team found that the average reduction in care costs per week increased with patients’ level of dependency, from £36 (about $44) among those in the low dependency group, to £519 (about $638) among those in the high dependency group.

Despite remaining in rehabilitation longer (average of 64.3 days) and incurring highest treatment costs (average of £28,974, or $35,662), patients in the high dependency group were those who had the shortest time taken to offset the cost of rehabilitation — average of 12.9 months, compared to 29.3 months in those with intermediate dependency, and 76.8 months in those with low dependency.

“[T]he most dependent patients were the costliest to treat, but generated the greatest savings in ongoing care costs, so that cost-efficiency was greatest in this group,” researchers wrote.

Overall, the team concluded that “specialist rehabilitation provided good value for money in patients with MS, yielding improved outcomes and substantial savings in ongoing care costs, especially in high-dependency patients.”

The team suggested that “rehabilitation should continue to be provided periodically in both inpatient and community settings throughout the patient’s lifetime.”