Inpatient care for people with multiple sclerosis - a secondary data analysis in Germany between 2019 and 2024

BACKGROUND: Multiple sclerosis (MS) is a chronic autoimmune disease imposing a substantial burden on healthcare systems. In Germany, MS care has been transitioning from inpatient to outpatient settings, driven by advances in disease-modifying therapies and evolving care infrastructure. Comprehensive data on inpatient utilisation trends and their determinants remain limited. OBJECTIVES: To analyse inpatient and day care admission patterns for people with MS (pwMS) in Germany between 2019 and 2024, examining trends by disease subtype, patient demographics, performed procedures, and regional distribution. METHODS: Administrative data from the Institute for Hospital Remuneration (InEK) were analysed for inpatient cases coded under ICD-10-GM G35 (MS) from 2019 to 2024. Cases were stratified by MS subdiagnosis (G35.X). Regional analysis incorporated population density data from Destatis and hospital listings from the Bundes-Klinik-Atlas. RESULTS: Nationwide inpatient MS admissions declined by 28%, from 45,067 cases in 2019 to 32,670 in 2024, while day care cases rose from 4,127 to 5,627. Regional variation in inpatient case reduction was substantial, ranging from - 11 to -59%. Declines were greatest for secondary progressive MS (37%) and primary progressive MS (31%). The average inpatient stay duration did not increase for admissions coded for first manifestation but did increase for all other disease courses. Diagnostic procedures dominated cases coded for first manifestation. Between 2019 and 2024, inpatient procedure rates per admission increased across most categories, and day care utilisation shifted markedly towards anti-CD20 immunotherapy administration. CONCLUSIONS: Inpatient MS care in Germany is declining substantially, with increasing day care utilisation partially compensating for this shift. Marked regional disparities and rising case complexity highlight the need for standardised outpatient care expansion and unified reimbursement frameworks.