Study links hard-to-manage gMG disease symptoms to higher costs
Crisis treatments, hospitalizations add to cost burden for patients
People with generalized myasthenia gravis (gMG) with many hospital visits before diagnosis or hard-to-manage disease symptoms at the time of diagnosis tend to accrue higher healthcare-related costs after getting diagnosed, a new study reports.
The use of certain treatments before diagnosis and in the year after, as well as a greater number of hospital visits and admissions, were also associated with greater healthcare costs.
“The consequences of poorly controlled gMG substantially increase the costs to patients and the healthcare system; hence, improving disease awareness to facilitate early diagnosis as well as implementing strategies for early disease control to prevent gMG progression may help reduce costs,” researchers wrote.
The findings “may help inform [health insurance providers] on potential cost-saving strategies by addressing the unmet care needs of this population,” they wrote.
The study, “Predictors of High Healthcare Cost Among Patients with Generalized Myasthenia Gravis: A Combined Machine learning and Regression Approach from a US Payer Perspective,” was published in Applied Health Economics and Health Policy. The work was funded by Janssen Scientific Affairs, part of the pharmaceutical arm of Johnson and Johnson.
Crises, exacerbations, hospitalizations drive costs higher
Like any chronic health condition, gMG can be costly to manage, but some patients will incur higher healthcare costs than others. Prior studies have shown that treatments used to manage myasthenic crises, myasthenia gravis exacerbations, and hospitalizations are the main drivers of high healthcare costs in gMG patients.
Scientists at Janssen and other institutions analyzed data from a U.S. insurance database, looking to identify factors that are present when gMG is diagnosed that could also be predictive of future healthcare costs for the patient.
“Knowledge of potential cost predictors may help identify unmet needs and inform strategies for cost savings for patients with gMG and the healthcare system both in the short term and over time,” the scientists wrote.
They noted that predictors of high healthcare costs can include disease features, as well as demographics and other variables. To take all these factors into account, the researchers used a machine learning model to analyze the data. Machine learning works by feeding a large dataset into a computer, alongside a set of mathematical rules (algorithms) that the computer uses to learn and identify patterns within the data.
The analysis included data on 2,739 people who were diagnosed with gMG from 2017 to 2021. Among these patients, 50.6% were female, 58.1% were commercially insured, and the average age at the time of diagnosis was about 56. More than 80% of patients had co-occurring health conditions (comorbidities), such as high blood pressure, diabetes, or psychiatric conditions.
In the overall group, average all-cause healthcare cost was $1,456 per month. The researchers defined high-cost patients as those at or above the 85th percentile, meaning monthly healthcare costs upwards of $9,404.
The study found that patients with more hospital visits, including both inpatient and outpatient visits, in the months before diagnosis tended to accrue higher costs in the months after diagnosis. More hospital visits before diagnosis may indicate that these patients had difficulty getting the correct diagnosis to manage their condition, the researchers noted.
Greater use of corticosteroids, a common class of anti-inflammatory medications, before diagnosis was also predictive of future high costs. Similarly, patients who had comorbidities or were diagnosed during a disease exacerbation (a flare, an episode in which symptoms suddenly worsen) also were more likely to have high healthcare costs.
In a subgroup of 1,638 patients with available data, the researchers conducted a similar analysis in which they looked for factors during the first year after gMG diagnosis that were predictive of high healthcare costs later on.
Factors identified by this analysis included more MG-related medical visits on different dates, greater use of corticosteroids, use of intravenous immunoglobulin (IVIG) to ease disease exacerbations, and using four or more different gMG-related treatments. All those factors are indicative of patients with hard-to-manage disease, the researchers said.
Collectively, the data “suggest that uncontrolled gMG symptoms and comorbidities are key contributors of high costs,” the researchers concluded. Based on the findings, they said, “there is a clear need to prevent progression of gMG as well as to manage comorbid conditions to minimize follow-up healthcare costs.”
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