Da Ros Alessandra [Dipartimento di Management – Università degli Studi di Verona, Verona, Italia]
Landi Stefano [Dipartimento di Management – Università degli Studi di Verona, Verona, Italia]
Leardini Chiara [Dipartimento di Management – Università degli Studi di Verona, Verona, Italia]
Maistri Gianluca [Dipartimento di Management – Università degli Studi di Verona, Verona, Italia]
Francesca Salaorni [Dipartimento di Neuroscienze, Biomedicina e Movimento – Università degli studi di Verona, Verona, Italia]
Giovanni Morone [Dipartimento di Medicina clinica, sanità pubblica, scienze della vita e dell’ambiente – Università degli Studi dell’Aquila, L’Aquila, Italia]
Sofia Straudi [Dipartimento di Neuroscienze e Riabilitazione – Università degli Studi di Ferrara, Ferrara, Italia]
Gabriele Perachiotti [Dipartimento di Neuroscienze e Riabilitazione – Università degli Studi di Ferrara, Ferrara, Italia]
Crestani Mauro [Università degli Studi di Verona, Verona, Italia]
Gandolfi Marialuisa [Università degli Studi di Verona, Verona, Italia]
Physiotherapy is essential to Multiple Sclerosis (MS) management and can be costly, especially if it involves frequent visits to a healthcare facility or the patient’s home. A recent study showed an increase in costs with a good increase in QoL, leading to a cost-effective Incremental Cost-Effectiveness Ratio (ICER) of around 14,000 €/QALYs of a home-based standing frame program1. Digital Telerehabilitation (DT) has the potential to improve patient outcomes while reducing costs by eliminating the need for frequent visits to a healthcare facility, reducing travel costs, and allowing patients to receive care from the comfort of their own homes.
Moreover, many people with MS might prefer DT combined with traditional rehabilitation programs due to its convenience and flexibility. DT allows patients to receive care at a time and place that suits them best, increasing their engagement with physiotherapy programs and improving adherence.
An economic assessment will establish the resources required to provide the new program, estimate intervention costs, and estimate cost-effectiveness. The economic evaluation will be carried out within the health technology assessment (HTA) framework, considering the perspective of the Italian National Healthcare System (NHS) and society as a whole.
This study aims to contribute to developing evidence-based physiotherapy programs for people with progressive MS that look at managerial aspects.
An economic evaluation of the introduction of a telemedicine program will be carried out within the HTA framework, considering the perspective of the healthcare system and society as a whole. It is “the comparative analysis of alternative courses of action in terms of both their costs and consequences”2 to provide robust information for informed choices and allocate resources for the greatest possible utility for the health systems and society.
The project proposes a single-blind RCT with two parallel arms to compare the effects between the experimental group (EG) and the control group (CG). Consecutive patients with primary (PPMS) and secondary progressive (SPMS) MS diagnoses referred to the participating units will be assessed for eligibility.
The volumes of health services will be collected at baseline encompassing the resources use 6 months prior to the start of the study and a T3 estimating the resource use during the entire trial duration3.
The DT program’s economic impact will be assessed by measuring different types of costs (i.e. program costs, direct healthcare costs, direct non-healthcare costs, and indirect costs)4.
The items used for the cost-effectiveness analysis will be the program costs (time of health professionals, materials used, etc.), the direct healthcare costs (as healthcare service uses, costs of outpatient health services, hospitalization and purchase of medications), direct non-healthcare costs (the costs of transportation and caregiving or informal care), indirect costs (as productivity loss due to treatments or disease setbacks)4. Regarding the implementation and management activities fixed and variable costs will be identified to understand the volume of patients involved to reach economic convenience for the fully operational DT program.
Direct healthcare costs will be assessed using the Multiple Sclerosis Health Resource Utilization Survey Multiple Sclerosis Health Resource Utilization Survey (MS-HRS) adapted for the Italian context5. The MS-HRS is validated instrument for resource use of MS’s patient.
The direct non healthcare cost collection will be based on the social part on iMTA Medical Consumption Questionnaire.
Indirect costs will be measured using validated log as the iMTA Productivity Cost Questionnaire for productivity loss6. This questionnaire is validated on a shorter time period and will be administered at T0, T2 and T3.
An economic evaluation of introducing the new technology will be carried out. In detail, cost and health outcomes will be synthesized in a cost-effectiveness model highlighting the DT program’s value for money (or not) vs. usual care. Two types of analyzes will be performed: 1) Analysis of the break-even point or Break-even analysis and 2) Cost-effectiveness (CEA) and cost-utility analysis (CUA). The final outcome measure will be the ICER.
The first outcome will be economically valorized from the point of view of the structure (e.g. the hospital) implementing DT programs, while the CEA will analyze also the societal perspective to estimate the costs for both the national health system and patients.
The results of this project will be relevant for advancing dedicated physiotherapy pathways for PPMS and SPMS patients through DT. Next to clinical outcomes, our results will support clinical guidelines on managing patients with PPMS and SPMS toward a more sustainable multiple sclerosis physical rehabilitation and provide preliminary data on cost-effectiveness to inform policymakers in the Italian NHS.
