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. 2022 Mar 3:10:822909.
doi: 10.3389/fpubh.2022.822909. eCollection 2022.

Socio-Economic Burden of Myasthenia Gravis: A Cost-of-Illness Study in Bulgaria

Valentina Ignatova  1 , Kostadin Kostadinov  2 , Evguenia Vassileva  3   4 , Naira Muradyan  3   4 , Georgi Stefanov  5 , Georgi Iskrov  2   5 , Rumen Stefanov  2   5
Affiliations

Socio-Economic Burden of Myasthenia Gravis: A Cost-of-Illness Study in Bulgaria

Valentina Ignatova et al. Front Public Health. .

Abstract

Background: Myasthenia gravis (MG) is a chronic autoimmune disorder, which is characterized by fatigable muscle weakness with frequent ocular signs and/or generalized muscle fatigue, and occasionally associated with thymoma. MG patients and their families face a significant socio-economic burden. This population is often experiencing unemployment, unwilling job transfers and decreased income.

Objective: This study aimed to estimate the annual costs from a societal perspective in a triple dimension of direct health care costs, direct non-health care costs (formal and informal care) and labor productivity losses in MG patients from Bulgaria, as well as to identify the main clinical and demographical cost drivers.

Methods: A bottom-up, cross-sectional, cost-of-illness analysis of 54 adult MG patients was carried out in 2020. To collect data on demographic characteristics, health resource utilization, informal care and productivity losses, questionnaires were administered to and completed by patients.

Results and conclusion: Median annual costs of MG in Bulgaria were 4,047 EUR per patient. Direct costs slightly outweighed indirect costs, with drugs cost item having the biggest monetary impact. Despite the zero-inflated median, hospitalizations also influenced the direct costs by an estimated amount of 1,512 EUR in the 3rd quartile. Social services and professional caregiver costs were found to be almost missing, with the vast majority of patients reporting reliance on informal caregivers. Severe generalized disease, disease crises, and recurrent infections were confirmed as statistically significant cost driving factors. There were no severe generalized MG patients in the bottom quartile of the total costs distribution. It should be noted that in both cases of crises or infections, the overall increase in the total costs was mainly due to higher indirect costs observed. Reliance on family members as informal caregivers is routine among Bulgarian MG patients. This phenomenon is likely due to the lack of access to appropriate social services. Moreover, it is directly related with higher disease burden and significant inequalities. There is a need for further research on MG in Bulgaria in order to design targeted health policies that meet the needs and expectations of these patients.

Keywords: Bulgaria; burden of disease; cost-of-illness; myasthenia gravis; societal costs; socio-economic burden.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Distribution of socio-economic burden in MG by infection rate (A) and crisis rate (B).
Figure 2
Figure 2
Decision tree analysis and main predicting factors for MG socio-economic burden (costs in EUR).
See this image and copyright information in PMC

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