Multi-Disciplinary ALS Clinics Are Cost-Effective within the Veterans Health Administration (P03.170)

Abstract

Objective: To determine if multi-disciplinary Amyotrophic Lateral Sclerosis (ALS) clinics within the Veterans Health Administration (VHA) are cost-effective. Background A 2003 prospective study regarding multi-disciplinary ALS clinics (Traynor et.al.) showed that such clinics increase survival by 7.5 months and decrease mortality by 29.7% when compared to general neurology clinics. The cost of these clinics is considerable as multiple different specialties (neurology, pulmonary, GI, PT, OT, social work) are involved with extended visit times. There have not been many studies to determine the cost-effectiveness of these clinics. The VHA is a unique system in that patients receive all their care within a single payer system, which allows for reliable cost analysis. Design/Methods: Multi-disciplinary ALS clinics were identified within the VHA. Data was obtained retrospectively for fiscal year (FY) 2010 through the Corporation Data Warehouse (CDW). Data merging and analysis were done through scrambled SSN; no patient identifiable information was used. ALS patients were identified by ICD-9 codes from the inpatient, outpatient and fee files. Results: There were 2752 patients with the diagnosis of ALS within the VHA in FY10 and 824 of these patients received care in multi-disciplinary clinics. The total average cost of ALS care per patient within the VHA for FY2010 was $41,529 versus $32,601 in multi-disciplinary ALS clinics. The average inpatient cost, outpatient cost and fee expenditure per patient was $15,421, $19,272, and $6836 nationally versus $12,222, $14,906 and $5205 in the multi-disciplinary clinics. Conclusions: Multi-disciplinary ALS clinics may be cost-effective when compared to traditional neurology clinics within the VHA. There is a 23% reduction in cost associated with the care provided in the multi-disciplinary clinics. There is no difference in the percentage of outpatient versus inpatient cost as a share of total cost in general neurology clinics as compared to multi-disciplinary clinics. Disclosure: Dr. Khokhar has nothing to disclose. Dr. Patwa has nothing to disclose.