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‘Measuring the burden of hospitalisation in multiple sclerosis: 
A cross-sectional analysis of the English Hospital Episode Statistics database 2009-2014’

Posted in Online First,Special Feature on 9th Feb 2016

Review by: Claire McCarthy

Multiple sclerosis (MS) is estimated to affect 89,790 people in England.1 This report, published in November 2015, looked at the reasons why people with MS are admitted to hospital and the cost implications. It has been produced by the NHiS Commissioning Excellence group in conjunction with the MS Trust. The first question I asked was who are the NHiS? The answer came from a news review by ACNR in April 2015. NHiS are a UK-based, private organisation who specialise in managing, analysing and interpreting healthcare data. The Commissioning Excellence directorate focuses on data relating to neurological conditions with an aim to allow commissioners and service providers to identify service gaps. NHiS collected data from the English Hospital Episode Statistics (HES) database which contains 1 billion records of patients who have been treated in hospital trusts in England.

The headline finding was that in 2013/14 non-elective (emergency) hospital admissions for people with MS in England cost the NHS £43 million.1 There were 23,665 non-elective admissions of people with MS, 37% of emergency admissions were repeat admissions.1 Unsurprisingly the most common reasons for admission were: urinary tract infections (14%), MS itself (10%), pneumonia and pneumonitis secondary to food aspiration.1 From 2010/2011 to 2013/14 the number of elective MS admissions increased due to the increase in day-case provision of disease modifying therapies.1 27% of the total admissions were emergency admissions but this equated to 46% of the overall spend on care for people with MS in hospital.1 Wide variations in admission rates and costs were noted nationally between CCGs. As there is no current, accurate record of MS prevalence across England the report could not conclude whether this variation was due to a difference in the numbers of patients with MS or a problem with community services in these areas.

The report concluded that MS Specialist Nurses, GPs and community rehabilitation teams are key in the prevention of hospital admissions for people with MS. It also supported the NICE recommendation that everyone with a diagnosis of MS should have an annual specialist review.2 Further work is needed to establish accurate local prevalence data for MS, which is essential for future service commissioning/planning.1

1. NHiS Commissioning Excellence and the MS Trust. Measuring the burden of hospitalisation in multiple sclerosis: A cross-sectional analysis of the English Hospital Episode Statistics database 2009-2014:, 2015.
2. National Institute for Health and Clinical Excellence (2014) Management of multiple sclerosis in primary and secondary care (Clinical Guideline 186). NICE, London UK.

ACNR 2016 V15:I6;19. Online 9/2/16