Economic Burden of Myasthenia Gravis Exacerbation and Crisis from US Payer Perspective
Daniel Labson1, Qian Cai1, Kavita Gandhi2, Maria Ait-Tihyaty3, Andreas Nikolaou4, Winghan Jacqueline Kwong1
1Janssen Global Services, Health Economics & RWE, USA, 2Janssen Global Services, Global Market Access Neuroscience, USA, 3Janssen Global Services, Global Medical Affairs Neuroscience, Canada, 4Janssen Global Services, Health Economics & RWE, Belgium
Objective:
To evaluate the impact of myasthenia gravis (MG) diagnosis, exacerbation, and crisis on healthcare costs. 
Background:
MG is a rare autoimmune neuromuscular disease characterized by muscle weakness and fatigability. Little is known about the changes in healthcare costs before and after MG diagnosis, as well as the impact of clinical deterioration events on the healthcare costs among MG patients.
Design/Methods:

Adults who had ≥1 inpatient or ≥2 outpatient claims (≥30 days apart) with MG diagnosis from 2017-2022, with ≥1 diagnosis provided by neurologist, and ≥12 months pre- and post-index (i.e., initial MG diagnosis) continuous enrollment were selected from the MarketScan® commercial and Medicare Supplemental databases. Patients with MG diagnosis during 12 months pre-index were excluded. MG exacerbation was defined as having a medical claim associated with MG acute exacerbation, the use of immunoglobulin or plasma exchange or MG-related hospitalization. MG crisis was defined as MG-related hospitalization associated with respiratory failure and endotracheal intubation/ventilation. Monthly all-cause healthcare costs before and after MG diagnosis were analyzed using restricted maximum likelihood controlling for age, gender, Charlson comorbidity index, and payer type.

Results:

A total of 891 newly diagnosed MG patients were identified [mean (±SD) age: 55.7 (±15.3) years; female: 52.7%; mean (±SD) Charlson comorbidity index: 1.2 (±1.6)]. All-cause costs increased by $1,163 per patient per month after MG diagnosis (P<0.0001) compared to pre-diagnosis. MG exacerbation and crisis further increased all-cause costs in the month that the event occurred by $13,283 and $81,840 per patient, respectively (both P<0.0001). On average, monthly all-cause costs continued to increase by $17 and $147 per patient for each additional month following MG exacerbation (P=0.011) and crisis (P<0.0001), respectively. 

Conclusions:
MG exacerbation and crisis were costly clinical events. Effective treatment reducing the risk of crisis/exacerbation can mitigate the economic burden of MG to the healthcare system. 
10.1212/WNL.0000000000208741
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