Abstract：
BACKGROUND: 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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
背景：重症肌无力（MG）的医疗保健成本和社会影响，一种可能危及生命的罕见药物，慢性神经肌肉疾病的研究很少。我们评估了瑞典新诊断（ND）和预先存在（PE）MG患者的医疗资源利用率（HCRU）和相关成本。
方法：这种观察，回顾性队列研究使用了4个可链接的瑞典全国人群登记处的数据.纳入2010年1月1日至2017年12月31日期间接受MG药物治疗且随访≥24个月的成人MG患者。
结果：共有1,275名患者被纳入分析，其中554例患者分为NDMG组，721例分为PEMG组。平均（±SD）年龄为61.3（±17.4）岁，女性占52.3％。在诊断后的第一年，ND患者对乙酰胆碱酯酶抑制剂的使用率明显更高（96.0%vs83.9%），皮质类固醇（59.6％和45.8％），胸腺切除术（12.1％vs0.7％）和血浆置换（3.8％vs0.6％）；与MGPE相比，全因（70.9％vs35.8％）和MG相关（62.5％vs18.4％）的住院率更高，住院天数增加11天（均p<0.01），住院风险增加（比值比[95％CI]=4.4[3.43，5.64]）。在诊断后的第一年，NDMG患者的总全因费用比PEMG高7302欧元（p<0.01），其中84%估计与MG相关，大多数(86%)与住院护理相关。在控制基线人口统计学和合并症之后,这些结果仍然显著(p<0.01)。在诊断后第二年，从第1年起，NDMG的全因医疗费用下降了约55%，与PEMG相当。
结论：在这项基于人群的研究中，与PEMG相比，MG患者在诊断后第1年需要更多的医疗保健资源，这主要是由于更多的药物治疗，胸腺切除术和相关住院。这些发现强调了需要更好地了解潜在因素，包括与增加卫生资源使用和成本相关的疾病特征，以及在疾病过程早期需要更有效的治疗。
方法：这种观察，回顾性队列研究使用了4个可链接的瑞典全国人群登记处的数据.纳入2010年1月1日至2017年12月31日期间接受MG药物治疗且随访≥24个月的成人MG患者。
结果：共有1,275名患者被纳入分析，其中554例患者分为NDMG组，721例分为PEMG组。平均（±SD）年龄为61.3（±17.4）岁，女性占52.3％。在诊断后的第一年，ND患者对乙酰胆碱酯酶抑制剂的使用率明显更高（96.0%vs83.9%），皮质类固醇（59.6％和45.8％），胸腺切除术（12.1％vs0.7％）和血浆置换（3.8％vs0.6％）；与MGPE相比，全因（70.9％vs35.8％）和MG相关（62.5％vs18.4％）的住院率更高，住院天数增加11天（均p<0.01），住院风险增加（比值比[95％CI]=4.4[3.43，5.64]）。在诊断后的第一年，NDMG患者的总全因费用比PEMG高7302欧元（p<0.01），其中84%估计与MG相关，大多数(86%)与住院护理相关。在控制基线人口统计学和合并症之后,这些结果仍然显著(p<0.01)。在诊断后第二年，从第1年起，NDMG的全因医疗费用下降了约55%，与PEMG相当。
结论：在这项基于人群的研究中，与PEMG相比，MG患者在诊断后第1年需要更多的医疗保健资源，这主要是由于更多的药物治疗，胸腺切除术和相关住院。这些发现强调了需要更好地了解潜在因素，包括与增加卫生资源使用和成本相关的疾病特征，以及在疾病过程早期需要更有效的治疗。
