IVIG Identified as a Treatment Marker of High Medical Costs, Resource Utilization in Patients With Myasthenia Gravis

Myasthenia gravis (MG), a chronic, autoimmune muscular disorder, can impact the livelihoods of patients in multiple ways, including emotionally, socially, and economically. The economic burden is especially difficult, with high average costs reported as a major obstacle for patients and those with severe disease having the most financial difficulties.^1,2

Intravenous immunoglobulin can be a costly and burdensome treatment for myasthenia gravis. | Image Credit: UlrikaArt | stock.adobe.com

Prior studies have attempted to determine patient and disease characteristics that could be attributed to higher costs for patients with MG, but the quality of the data is limited. One study from outside Europe found that a large portion of costs associated with MG result from the use of IVIG, an agent recommended for the treatment of the condition and associated complications, particularly in those who receive infusions often.^1,3

Those findings are difficult to extrapolate due to the differences in health care systems. Now, new study results from an analysis of nationwide patient-level data from Norway show that the use of IVIG is a marker for especially high medical costs and health care resource utilization among patients who utilize it.¹

A total of 1083 patients with MG who had at least 2 MG-related hospital encounters from 2010 through 2021 were identified by the investigators. IVIG treatment was utilized in 14.3% (n = 155) of patients, with 4.9% (n = 53) receiving IVIG in the first year only and 9.4% (n = 102) treated with IVIG in their second year or later.¹

Patients had an overall mean of 4.4 inpatient hospital stays and 9.1 outpatient encounters from their index date. However, among IVIG patients, the mean number of inpatient stays was 9.9, while they had a mean of 20.6 outpatient encounters. These numbers were higher for patients treated after the first year, with inpatient and outpatient encounters at 11.1 and 25.2 respectively. This trend continued for patients who received IVIG as maintenance treatment with a mean number of inpatient stays of 11.7 and mean outpatient encounters of 33.6.¹

Hospital costs were significantly higher among patients receiving IVIG, with mean MG-related hospital costs of EUR 95,364 ($100,232) compared with EUR 38,457 ($40,420) per patient among all those with MG. Costs were even higher for patients treated with IVIG after the first year and for those on IVIG maintenance therapy.¹

A major strength of these trial results resides in the use of nationwide registry data that covers the entire population of Norway, following patients for up to 12 years. The investigators remarked upon Norway’s public health infrastructure, which has very little barriers to access an almost no co-payments for patients in addition to a history of mandatory data collection in public registries. Beneficially, these aspects dilute the impact of selection bias, while it eases the process of identifying patients with MG and IVIG treatment.¹

Attributes of IVIG treatment, including its invasiveness, tendency to elicit side effects, and high price tag can help explain its association with high resource utilization and financial impacts. Due to its common use as a treatment for myasthenic crisis and severe exacerbations of MG, it makes sense that the treatment is a relevant marker for the severity of MG.¹

“Our results illustrate that IVIG treatment is an important marker of direct medical costs associated with MG,” the study authors wrote. “Changes in these costs should be accounted for when evaluating new therapeutic interventions.”¹

REFERENCES

1. Bugge C, Engebretsen I, Kristiansen I, et al. Medical costs of treating myasthenia gravis in patients who need intravenous immunoglobulin (IVIg) – a register-based study. J Neurol. 2024;272(1):15. doi:10.1007/s00415-024-12768-5

2. Halpern L. Myasthenia gravis negatively impacts patients and care partners through clinical, financial burdens. Pharmacy Times. Published October 21, 2024. Accessed December 16, 2024. https://www.pharmacytimes.com/view/myasthenia-gravis-negatively-impacts-patients-and-care-partners-through-clinical-financial-burdens

3. Guptill JT, Marano A, Krueger A, et al. Cost analysis of myasthenia gravis from a large US insurance database. Muscle & Nerve. 2011;44(6):907-911. doi:10.1002/mus.22212