Healthcare resource utilization and costs for multiple sclerosis management in the Campania region of Italy: Comparison between centre-based and local service healthcare delivery.

BACKGROUND: Multiple sclerosis (MS) requires multidisciplinary management. We evaluated differences in healthcare resource utilization and costs between Federico II and Vanvitelli MS Centres of Naples (Italy), representative of centralised (i.e., MS Care Unit) and local service-based models of multidisciplinary care, respectively. METHODS: We included MS patients continuously seen at the same local healthcare services and MS Centre (Federico II = 187; Vanvitelli = 90) from 2015 to 2017. Healthcare resources for MS treatment and management were collected and costs were calculated. Adherence was estimated as the rate of medication possession ratio (MPR) during 3-years of follow-up. Mixed-effect linear regression models were used to estimate differences in all outcomes between Federico II and Vanvitelli. RESULTS: Patients at Federico II had more consultations within the MS centre (p<0.001), blood tests (p<0.001), and psychological/cognitive evaluations (p = 0.040). Patients at Vanvitelli had more consultations at local services (p<0.001). Adherence was not-significantly lower at Vanvitelli (p = 0.060), compared with Federico II. Costs for MS treatment and management were 10.6% lower at Vanvitelli (12417.08±8448.32EUR) (95%CI = -19.0/-2.7%;p = 0.007), compared with Federico II (15318.57±10919.59EUR). DISCUSSION: Healthcare services were more complete (and expensive) at the Federico II centralised MS Care Unit, compared with the Vanvitelli local service-based organizational model. Future research should evaluate whether better integration between MS Centres and local services can lead to improved MS management and lower costs.

[Gastric protection against non-steroidal and steroidal antiinflammatory agents in internal medicine specialties: survey on prescription trends among hospital internal medicine physicians (Gardenia Project)]. / La gastroprotezione da farmaci antinfiammatori non steroidei e steroidi nelle divisioni di medicina interna: indagine sugli orientamenti prescrittivi dei medici internisti ospedalieri (Progetto Gardenia).

Hospital physicians employed in 37 departments of medicine in the Regions of Campania and Molise were asked to reply to a questionnaire aimed at evaluating, among their inpatients, the real extent of gastrointestinal side effects caused by nonsteroidal anti-inflammatory drugs and steroids, and to point out which gastroprotective drugs they thought were preferable in various clinical situations. In this way, a study group of internists has gathered information about the outlook of internists towards gastroprotection; they have also calculated the pharmacoeconomic burden of these measures.