Analysis of Methylprednisolone Treatment of Multiple Sclerosis
S. Robson, Charlene Bain, Shann Beck, Suzanne Guthrie, Peter
C. Coyte and Paul O'Connor
Background: Intravenous methylprednisolone (IVMP)
is the treatment of choice for multiple sclerosis (MS) patients
undergoing acute exacerbation of disease symptoms and yet its
cost has not been accurately determined. Determination of this
cost in different settings is also pertinent to consideration
of cost-saving alternatives to in-patient treatment. Methods:
Cost analysis from the point of view of the health care system
of IVMP treatment of MS patients receiving treatment in association
with a selected Toronto teaching hospital in fiscal year 1994/95
was carried out. Costs of any concurrent treatments were excluded.
Results: Total cost for 92 patients, based on
a 4 dose regime, was estimated to be $78,527. The the cost per
patient was $1,1181.84 for in-patients (IP), $714.64 for out-patients
of the MS Clinic (OP) and $774.21 for patients whose treatment
was initiated in the Clinic, but completed in the home (HC).
Sensitivity analyses indicated: 1) IP treatment was in all cases
more expensive than that of OP or HC; 2) the cost savings of
OP vs. HC was sensitive to assumptions made regarding Clinic
overhead, Clinic nursing costs and Home Care Program overhead.
Conclusion: Alternatives to in-patient care must
be considered carefully. In this study, both out-patient and
in-home treatment were cost-saving alternatives to in-patient
treatment, but large differences in the cost of hospital out-patient
vs. in-home care could not be demonstrated.
J. Neurol. Sci. 1998; 25: 222-229