Objectives: MG is a debilitating chronic illness characterized by muscle weakness, potentially life-threatening exacerbations and high costs. We sought to further quantify the humanistic and economic burden by reviewing published evidence. Methods: Using PRISMA guidelines, two systematic literature reviews were conducted, one for quality of life (QOL) and one for economic studies, in key biomedical literature databases, Embase, Ovid Medline and Cochrane. Additionally, only studies published between 2009-2019 were identified. Results: A total of 957 abstracts from the QOL search and 521 from the economic search underwent screening. A total of 81 QOL and 41 economic studies were selected. A variety of QOL tools were used, including SF-36, EQ-5D, HADS, MG-ADL, MG-QOL15, QMG and MGC among others. The only study mapping utility values found a range of 0.94-0.20 across MGFA classifications, indicating a major QOL deterioration related to disease severity. Deterioration was further supported in other studies which found increased levels of chronic fatigue, sleep disturbances and anxiety/depression with MG. Refractory patients experienced significantly worse deteriorations across various scales. Employment status and medication adherence were also negatively affected. Of 41 economic studies, 32 were related to cost/healthcare resource use, while 9 described economic models. The average US cost in 2013 was $98,795 per MG hospitalization and the gross hospitalization cost in the HCUP database had risen more than 13-fold since 2003 totalling $546,834,101. Inpatient, outpatient and home costs were found to account for 27%, 23% and 23% of MG healthcare costs. A US claims database found annual costs to be approximately 4 times higher in refractory vs. non-refractory patients ($109,004 vs. $24,196, p,0.001), possibly related to a higher use of IVig/ PLEX, costly therapies according to economic models. Conclusions: Novel treatment strategies are necessitated to help control rising costs and alleviate the humanistic burden associated with MG, especially in refractory patients.
Objective: To evaluate the effect of comorbidities on healthcare expenditures and perceived physical and mental health status among adults with multiple sclerosis (MS) compared to propensity score-matched non-MS controls. Methods: A retrospective, cross-sectional, matched cohort study was conducted using Medical Expenditure Panel Survey (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) data. The base study sample consisted of adults (age ≥18 years) who were alive and had positive total healthcare expenditures during the survey calendar year. Adults with MS were propensity-matched (1:1) to non-MS controls based on age, gender, and race/ethnicity using greedy matching algorithm. Healthcare expenditures consisted of total and subtypes of expenditures. Health status consisted of perceived physical and mental health status. Comorbidities were identified using ICD-9-CM and Clinical Classification System codes. Ordinary least squares regression and multinomial logistic regression were used to analyze the healthcare expenditures and health status variables, respectively. Results: Final study sample consisted of 541 adults in each MS and non-MS control groups after propensity score matching. After adjusting for potential confounders, individuals with MS had greater total and subtypes of expenditures compared to non-MS controls, and several comorbidities (eg, depression, hypertension) were significantly associated with increased healthcare expenditures. Yearly average total expenditures (expressed in 2018 US$) were significantly (p<0.001) higher for adults with MS ($29,396) than propensity score-matched non-MS adults ($7875). Moreover, after adjusting for all individual-level factors, adults with MS experienced 363% (p<0.001) higher total expenditures compared to propensity score-matched non-MS controls. Individuals with MS were more likely to report poorer physical and good mental health status compared to propensity scorematched non-MS controls, and several comorbidities (eg, anxiety, depression) were significant independent predictors of poorer health status. For example, adults with MS were four times more likely (OR: 4.10, 95% CI: 2.42-6.96) to report fair/poor physical health status compared to excellent/very good physical health status compared with non-MS controls. Adults with MS were 42% (OR: 1.42, 95% CI: 1.01-1.99) more likely than propensity score-matched non-MS controls to report good rather than very good or excellent mental health status. However, there was no difference between adults with MS and propensity score-matched non-MS controls in terms of reporting fair or poor than very good or excellent mental health status. Conclusion: Findings from this study indicate substantial economic and health status burdens among adults with MS at the US national-level that are significantly influenced by comorbidities.
RWS were identified. Most studies included medical records (67.6%), were retrospective (52.0%) and were non-interventional (54.9%). The number of RWS increased 7-fold in the last decade (24 articles in 2009 and 169 articles in 2019). Any COA was reported in 55.4% (n=601) of RWS. Similar to the increase in RWS, studies reporting any COA showed an 8-fold increase in the last decade (11 vs 92 articles). Over 200 different COAs were identified, with EDSS being the most prevalent (65.2%, n=392). Other COAs identified in RWS included quality of life (9.0%), cognition (11.6%), neuropsychiatric symptoms (14.1%) and productivity (5.8%). Conclusions: The increase in both total RWS and subsequent reporting of COAs in RRMS reflects the increasing need and transparency for RWE and COAs to stakeholders. However, despite the relatively good integration of EDSS in RWE reporting, COAs reporting on other aspects of RRMS important to the patient experience is still poorly integrated and diverse.
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