Epidemiology and treatment of myasthenia gravis: a retrospective study using a large insurance claims dataset in Germany

Mevius, Antje; Jöres, Lars; Biskup, Jutta; Heidbrede, Tanja; Mahic, Milada; Wilke, Thomas; Maywald, Ulf; Lehnerer, Sophie; Meisel, Andreas

doi:10.1016/j.nmd.2023.02.002

Cited by 16 publications

(16 citation statements)

References 35 publications

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“…The observed decline in thymectomy rates (from 24.5% of patients treated in 2015 to 12.6% in 2020) could be due to reluctance from clinicians to undertake the procedure due to relatively weak evidence of effectiveness; the practice guideline by the Association of British Neurologists published in 2018 6 states thymectomy may induce remission, may prevent generalization of ocular myasthenia, and may reduce corticosteroid requirements. Similar to our study, a recent German study 19 reported a low rate of thymectomy (4.4% of the total MG incident cohort), which the authors interpreted as likely being caused by the refusal of procedures due to older age and the presence of comorbidities. Notably, the rate of thymectomies in the early-onset MG subgroup was higher at 13.3%.…”

Section: Discussionsupporting

confidence: 91%

“…Only 2.9% ( n = 268) of patients were recorded to have undergone thymectomy, similar to 2.6% of MG patients in a previous study of MG patients in England. 9 In a recent study in Germany, 19 29.9% of incident patients experienced exacerbations, and 6.7% experienced myasthenic crises during the follow-up period (mean ± SD: 846.5 ± 528.5 days), most occurring within the first year after diagnosis. The high reported rate of exacerbations and crises in the German study may be attributed to the inclusion criteria, which required patients to have received at least one inpatient and/or two confirmed outpatient diagnoses of MG in the period, or to differences in the healthcare system.…”

Section: Discussionmentioning

confidence: 97%

“…Our findings align with a recent German study using anonymized insurance claims data, which reported an MG incidence of 4.6 cases per 100,000 individuals between 2015 and 2019. 19 A previous UK study based on primary care data, however, reported a lower incidence rate ratio of 2.46 (CI: 2.34–2.59) per 100,000 person-years, 3 though imprecision may arise from the absence of validated diagnoses in primary care records.…”

Section: Discussionmentioning

confidence: 98%

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A retrospective observational study on characteristics, treatment patterns, and healthcare resource use of patients with myasthenia gravis in England

van Enkhuizen,

Binns,

Betts

et al. 2024

Ther Adv Neurol Disord

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Background: There are limited data on the real-world healthcare resource use (HCRU) and management costs of myasthenia gravis (MG) in England. Objective: This study aims to assess the burden of disease for patients with MG in England. Design: A retrospective, observational cohort study of adult patients diagnosed with MG, using data from the Hospital Episode Statistics data warehouse. Methods: Patients with a first-ever recorded diagnosis of MG between 30 June 2015 and 30 June 2020 were followed up until 30 June 2021 or death, whichever occurred first. Post-diagnosis patient characteristics, treatment patterns, HCRU, and costs were described. Costs were evaluated using National Health Service reference costs. Results: A total of 9087 patients with a median follow-up time of 2.9 years (range, 1.7–4.3 years) were included. The mean age at diagnosis was 66.5 years and 53% of the patients were male. A large proportion of patients (72.8%) were admitted as inpatients during follow-up with a mean number of 1.3 admissions. Patients hospitalized for MG-related complications spent a mean of 9.7 days per patient-year in the hospital. During follow-up, 599 (6.6% of the total cohort) and 163 (1.8%) patients had a record of rescue therapy with intravenous immunoglobulin (IVIg) and plasma exchange (PLEX), respectively. Rituximab was administered to 81 (0.9%) patients and 268 (2.9%) patients underwent thymectomy. In those patients receiving rescue therapy or rituximab, >10% received at least three cycles of the same treatment. The average annual cost of hospital admissions across all patients treated with IVIg, PLEX, and rituximab were £907,072, £689,979, and £146,726, respectively. Conclusion: A majority of MG patients required hospitalization or accident and emergency attendance, resulting in high HCRU and costs. A subset of patients required rescue therapy (including IVIg and PLEX), rituximab administration, ventilation, or thymectomy.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

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A retrospective observational study on characteristics, treatment patterns, and healthcare resource use of patients with myasthenia gravis in England

van Enkhuizen,

Binns,

Betts

et al. 2024

Ther Adv Neurol Disord

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“…Our study indicates that MG in Norway is more frequent than reported previously. Our results correspond well to international estimates based on recent data [18, 19], but our estimated prevalence is somewhat lower that what is reported in recent studies from Germany (393 per million) and Spain (260 per million) [19, 20]. We do not know whether MG has become more common, if some cases had remained undiagnosed previously, or if previous studies missed some diagnosed cases.…”

Section: Discussionsupporting

confidence: 73%

The epidemiology and societal costs of myasthenia gravis in Norway: A non‐interventional study using national registry data

Engebretsen,

Gilhus,

Kristiansen

et al. 2024

Euro J of Neurology

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Background and purposeWith the emergence of new treatment options for myasthenia gravis (MG), there is a need for information regarding epidemiology, healthcare utilization, and societal costs to support economic evaluation and identify eligible patients. We aimed to enhance the understanding of these factors using nationwide systematic registry data in Norway.MethodsWe received comprehensive national registry data from five Norwegian health‐ and work‐related registries. The annual incidence and prevalence were estimated for the period 2013–2021 using nationwide hospital and prescription data. The direct, indirect (productivity losses) and intangible costs (value of lost life‐years [LLY] and health‐related quality of life [HRQoL]) related to MG were estimated over a period of 1 year.ResultsIn 2021, the incidence of MG ranged from 15 to 16 cases per year per million population depending on the registry used, while the prevalence varied between 208.9 and 210.3 per million population. The total annual societal costs of MG amounted to EUR 24,743 per patient, of which EUR 3592 (14.5%) were direct costs, EUR 8666 (35.0%) were productivity loss, and EUR 12,485 (50.5%) were lost value from LLY and reduced HRQoL.ConclusionThe incidence and prevalence of MG are higher than previously estimated, and the total societal costs of MG are substantial. Our findings demonstrate that productivity losses, and the value of LLY and HRQoL constitute a considerable proportion of the total societal costs.

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“…Die Myasthenia gravis (MG) ist formal eine seltene neurologische Erkrankung. Mit einer Prävalenz von bis zu 40/100.000 tritt sie etwa 5-mal seltener auf als das idiopathische Parkinsonsyndrom oder die Multiple Sklerose, jedoch 5–10-mal häufiger als andere neurologische Erkrankungen, wie die Amyotrophe Lateralsklerose oder die chronisch-inflammatorische demyelinisierende Polyneuropathie 1 . Die MG ist als paradigmatische Autoimmunerkrankung, paraneoplastisches Syndrom und Erkrankung, an der die neuromuskuläre Übertragung exemplarisch dargestellt werden kann, den meisten ÄrztInnen aus dem Studium bekannt.…”

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Myasthenie in der neurologischen Praxis

Funke¹

2023

Klinische Neurophysiologie

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Epidemiology and treatment of myasthenia gravis: a retrospective study using a large insurance claims dataset in Germany

Cited by 16 publications

References 35 publications

A retrospective observational study on characteristics, treatment patterns, and healthcare resource use of patients with myasthenia gravis in England

A retrospective observational study on characteristics, treatment patterns, and healthcare resource use of patients with myasthenia gravis in England

The epidemiology and societal costs of myasthenia gravis in Norway: A non‐interventional study using national registry data

Myasthenie in der neurologischen Praxis

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