Long-Term Healthcare Resource Utilization and Costs among Patients with Myasthenia Gravis: A Swedish Nationwide Population-Based Study

Abstract

Introduction: Healthcare costs and societal impact of myasthenia gravis (MG), a potentially life-threatening rare, chronic neuromuscular disease, are sparsely studied. We assessed healthcare resource utilization (HCRU) and associated costs among patients with newly diagnosed (ND) and preexisting (PE) MG in Sweden.

Methods: This observational, retrospective cohort study used data from four linkable Swedish nationwide population-based registries. Adult MG patients receiving pharmacological treatment for MG and having ≥24-month follow-up during the period January 1, 2010, to December 31, 2017, were included.

Results: A total of 1,275 patients were included in the analysis, of which 554 patients were categorized into the ND MG group and 721 into the PE MG group. Mean (±SD) age was 61.3 (±17.4) years, and 52.3% were female. In the first year post-diagnosis, ND patients had significantly higher utilization of acetylcholinesterase inhibitors (96.0% vs. 83.9%), corticosteroids (59.6% vs. 45.8%), thymectomy (12.1% vs. 0.7%), and plasma exchange (3.8% vs. 0.6%); had higher all-cause (70.9% vs. 35.8%) and MG-related (62.5% vs. 18.4%) hospitalization rates with 11 more hospitalization days (all p < 0.01) and an increased risk of hospitalization (odds ratio [95% CI] = 4.4 [3.43, 5.64]) than PE MG. In year 1 post-diagnosis, ND MG patients incurred EUR 7,302 (p < 0.01) higher total all-cause costs than PE MG, of which 84% were estimated to be MG-related and the majority (86%) were related to inpatient care. These results remained significant also after controlling for baseline demographics and comorbidities (p < 0.01). In year 2 post-diagnosis, the all-cause medical costs decreased by ∼55% for ND MG from year 1 and were comparable with PE MG.

Conclusion: In this population-based study, MG patients required significantly more healthcare resources in year 1 post-diagnosis than PE MG primarily due to more pharmacological treatments, thymectomies, and associated hospitalizations. These findings highlight the need to better understand potential factors including disease characteristics associated with increased health resource use and costs and need for more efficacious treatments early in the disease course.

Keywords: Healthcare costs; Myasthenia gravis; Resource utilization; Sickness absence.

Fig. 1.

Patient inclusion flowchart. *Diagnosis as per the Swedish version of the International Classification of Diseases Version 10 (ICD-10-SE: G70.0). At least one diagnosis must have been a primary MG diagnosis filed by neurologist specialists in an inpatient or outpatient specialist visit from January 1, 2010, to December 31, 2017. Index date: date of the first primary MG diagnosis between January 1, 2010, and December 31, 2017. ^≠To ensure confirmed diagnosis of MG, patients were also required to have ≥1 record of AChEis, NSIST, CSs, rituximab, eculizumab, intravenous immunoglobulin, subcutaneous immunoglobulin, PLEX. AChEis, acetylcholinesterase inhibitors; MG, myasthenia gravis; NSIST, nonsteroidal immunosuppressive therapy.

Fig. 2.

MG-related treatment utilization for ND versus PE MG patients. AChE, acetylcholinesterase; MG, myasthenia gravis; ND, newly diagnosed; PE, preexisting; NSIST, nonsteroidal immunosuppressive therapy.

Fig. 3.

Hospitalization for ND versus PE MG patients. MG, myasthenia gravis; ND, newly diagnosed MG; PE, preexisting MG.

Fig. 4.

Healthcare costs for ND versus PE MG patients. Medical cost: inpatient cost + outpatient cost. MG, myasthenia gravis; ND, newly diagnosed MG; PE, preexisting MG; Rx, prescription drug.

Fig. 5.

Direct and indirect costs for ND versus PE MG among employed MG patients (n = 370). MG, myasthenia gravis; ND, newly diagnosed; PE, preexisting; Rx, prescription drug.