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

PLoS One. 2019 Sep 19;14(9):e0222012. doi: 10.1371/journal.pone.0222012. eCollection 2019.


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.

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Delivery of Health Care / organization & administration
  • Female
  • Health Care Costs
  • Health Services
  • Humans
  • Immunologic Factors / economics*
  • Immunologic Factors / therapeutic use*
  • Italy
  • Linear Models
  • Male
  • Medication Adherence
  • Middle Aged
  • Multiple Sclerosis / drug therapy*
  • Multiple Sclerosis / economics*
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Retrospective Studies
  • Treatment Outcome


  • Immunologic Factors

Grant support

This research was partially supported by Merck S.p.A., (Italy), an affiliate of Merck KGaA, Darmstadt, Germany. The funder provided support in the form of research grant to the Department of Public Health (“Federico II” University of Naples, 2018, Italy) to MT, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. A preliminary draft of the current paper was reviewed by the sponsor, and its latest version was approved by all co-authors. The specific roles of these authors are articulated in the ‘author contributions’ section.