Comparison of specialist ataxia centres with non-specialist services in terms of treatment, care, health services resource utilisation and costs in the UK using patient-reported data.

Abstract

OBJECTIVES: This study aims to assess the patient-reported benefits and the costs of coordinated care and multidisciplinary care at specialist ataxia centres (SACs) in the UK compared with care delivered in standard neurological clinics. DESIGN: A patient survey was distributed between March and May 2019 to patients with ataxia or carers of patients with ataxia through the Charity Ataxia UK's mailing list, website, magazine and social media to gather information about the diagnosis, management of the ataxias in SAC and non-specialist settings, utilisation of various healthcare services and patients' satisfaction. We compared mean resource use for each contact type and health service costs per patient, stratifying patients by whether they were currently attending a SAC or never attended one. SETTING: Secondary care including SACs and general neurology clinics. PARTICIPANTS: We had 277 participants in the survey, aged 16 years old and over, diagnosed with ataxia and living in the UK. PRIMARY OUTCOME MEASURES: Patient experience and perception of the two healthcare services settings, patient level of satisfaction, difference in healthcare services use and costs. RESULTS: Patients gave positive feedback about the role of SAC in understanding their condition (96.8% of SAC group), in coordinating referrals to other healthcare specialists (86.6%), and in offering opportunities to take part in research studies (85.2%). Participants who attended a SAC reported a better management of their symptoms and a more personalised care received compared with participants who never attended a SAC (p<0.001). Costs were not significantly different in between those attending a SAC and those who did not. We identified some barriers for patients in accessing the SACs, and some gaps in the care provided, for which we made some recommendations. CONCLUSIONS: This study provides useful information about ataxia patient care pathways in the UK. Overall, the results showed significantly higher patient satisfaction in SAC compared with non-SAC, at similar costs. The findings can be used to inform policy recommendations on how to improve treatment and care for people with these very rare and complex neurological diseases. Improving access to SAC for patients across the UK is one key policy recommendation of this study.