IVIG treatment for MG linked with high medical costs in Norway: Study
Patients treated with IVIG received more inpatient, outpatient care
Myasthenia gravis (MG) patients in Norway who were treated with intravenous immunoglobulin (IVIG) had 2.3 times higher direct medical costs during the first year after a diagnosis than those who didn’t receive IVIG treatment.
That’s according to a study that also found that people with MG treated with IVIG still had higher costs and resource utilization five years after their diagnosis.
“[IVIG] treatment represents an important marker for high direct medical costs among patients with MG. The costs continue to be high during the first five years after MG diagnosis,” the researchers wrote. The study, “Medical costs of treating myasthenia gravis in patients who need intravenous immunoglobulin (IVIg) – a register-based study,” was published in the Journal of Neurology.
MG is a rare autoimmune condition marked by muscle weakness and fatigue. It’s caused by self-reactive antibodies that target important proteins at the neuromuscular junction, where nerve and muscle cells communicate to coordinate voluntary movements.
IVIG preparations contain immunoglobulins, or antibodies, collected from the blood of healthy donors. When these immunoglobulins are infused intravenously, or into a vein, it’s believed they temporarily modulate the immune system to minimize the damaging autoimmune response that drives MG. The therapy is recommended primarily as a short-term treatment for sudden or severe worsening of MG symptoms or a myasthenic crisis, a potentially life-threatening event where MG-related muscle weakness affects respiratory muscles, impairing a person’s ability to breathe.
Norwegian MG patients have high direct medical costs for inpatient and outpatient medical care and medications, research has shown. But the direct medical costs vary between patients and the reasons for these differences in MG-related expenses aren’t well understood.
“Knowledge about factors contributing to cost variation in MG and the characteristics of patients with high treatment costs is limited,” the researchers wrote.
Assessing resource use for MG treatment
Here, researchers assessed resource utilization and direct medical costs for MG patients treated with IVIG. They used data from 1,083 people with MG who had at least two MG-related hospital visits from 2010 to 2021. Of these, 155 (14.3%) were treated with IVIG.
MG patients who didn’t receive IVIG had a mean of 3.5 inpatient hospital stays and 7.2 outpatient doctor visits. IVIG-treated patients received more inpatient care, a mean of 9.9 hospital stays, and more outpatient doctor visits, with a mean of 20.6 outpatient encounters.
Researchers also examined inpatient and outpatient care visits for smaller subgroups of patients treated with IVIG.
Of the 155 IVIG-treated patients, 53 received IVIG in only the first year after their diagnosis. This subgroup had a mean of 7.5 hospital stays and 11.6 outpatient doctor visits.
Another subgroup of 102 patients who received IVIG two or more years after a diagnosis had a mean of 11.1 hospital stays and 25.2 outpatient doctor visits. A final subgroup of 37 patients received IVIG maintenance therapy. The maintenance treatment group had the highest mean number of inpatient hospital stays (11.7) and the highest mean number of outpatient encounters (33.6).
Comparing medical costs for MG treatment
The researchers also calculated MG-related hospital costs per patient.
Patients who didn’t receive IVIG had a mean MG-related cost of €28,952 ($30,391). The mean MG-related cost was higher for IVIG-treated patients, at €95,364 ($100,105).
Patients who received IVIG in the first year had a mean cost of €71,934 ($75,510) and those who received IVIG two or more years after a diagnosis had a mean MG-related cost of €107,538 ($112,884). The subgroup who received IVIG maintenance treatment had the highest mean hospital costs per patient, at €111,148 ($116,674).
The researchers also examined the annual direct medical costs over five years after an MG diagnosis.
While the annual cost of hospital encounters per patient during the first year after an MG diagnosis was €15,457 ($16,225) for those who didn’t receive IVIG, it was €35,714 ($37,489) for those who did. IVIG-treated patients also had higher costs in the second and third years after a diagnosis than MG patients who didn’t receive IVIG.
In the fifth year after an MG diagnosis, the mean annual cost of hospital encounters still differed between the groups. The mean costs were €9,953 ($10,447) for IVIG-treated patients and €5,634 ($5,914) for those not treated with IVIG.
“IVIG treatment is a marker of high medical costs in patients with MG. The expected and real changes in such costs should be accounted for when evaluating new interventions,” the researchers wrote.
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