BACKGROUND: Myasthenia gravis (MG) is a rare autoimmune disorder with significant clinical implications, including life-threatening myasthenic crises and exacerbations. Understanding real-world treatment patterns, especially associated direct medical costs, is essential for the effective management of healthcare delivery. METHODS: We conducted a descriptive cohort study using health administrative claims data from the Czech Republic covering more than 1,500 prevalent MG patients. Data were analysed for healthcare resource utilization, medication costs, and hospitalization rates related to MG and its complications. RESULTS: Acetylcholine inhibitors and corticosteroids were widely prescribed, with 91.1% and 75.2% of patients receiving them at least once, respectively. Immunosuppressive therapy was given to 45.2% of patients. Myasthenic crises occurred in 2% of patients, with a mean hospitalization cost of 21,020 EUR, while exacerbations occurred in 9.2% of patients, with lower costs (5,951 EUR per hospitalization). Outpatient intravenous immunoglobulin and plasma exchange therapies incurred additional costs of 20,700 EUR and 18,206 EUR per person-year, respectively. The mean total cost per patient-year was 1,271 EUR, with significant cost differences among patients with different treatment patterns. CONCLUSION: This study offers real-world insights into the treatment patterns and associated direct medical costs of MG in the Czech Republic. Myasthenic crises and exacerbations pose considerable cost burdens, while outpatient therapies and common pharmacotherapies are less costly. These findings are vital for healthcare planning, economic evaluation, and resource allocation, potentially leading to enhanced patient care and outcomes.

Department of Biomedical Technology Czech Technical University Prague Kladno Czech Republic

Department of Neurology ERN EURO NMD Center University Hospital Brno Brno Czech Republic

Faculty of Medicine Masaryk University Brno Czech Republic

See more in PubMed

Landfeldt E, Pogoryelova O, Sejersen T, Zethraeus N, Breiner A, Lochmüller H. Economic costs of myasthenia gravis. Syst Rev PharmacoEconomics. 2020;38:715–28. 10.1007/s40273-020-00912-8 PubMed

Engel-Nitz NM, Boscoe A, Wolbeck R, Johnson J, Silvestri NJ. Burden of illness in patients with treatment refractory myasthenia gravis. Muscle Nerve. 2018;58:99–105. 10.1002/mus.26114 PubMed

Mandawat A, Kaminski HJ, Cutter G, Katirji B, Alshekhlee A. Comparative analysis of therapeutic options used for myasthenia gravis. Ann Neurol. 2010;68:797–805. 10.1002/ana.22139 PubMed

Hughes T, Anderson AEL, Habib AA, Perez K, Bergin C, Suchotliff S, et al. Impact of social determinants of health on individuals living with generalized myasthenia gravis and implications for patient support programs. Front Public Health. 2023;11. 10.3389/fpubh.2023.1147489 PubMed PMC

Salari N, Fatahi B, Bartina Y, Kazeminia M, Fatahian R, Mohammadi P, et al. Global prevalence of myasthenia gravis and the effectiveness of common drugs in its treatment: a systematic review and meta-analysis. J Translational Med. 2021;19:516. 10.1186/s12967-021-03185-7 PubMed PMC

Ignatova V, Kostadinov K, Vassileva E, Muradyan N, Stefanov G, Iskrov G et al. Socio-economic burden of myasthenia gravis: a cost-of-illness study in Bulgaria. Front Public Health. 2022;10. PubMed PMC

Bubuioc A-M, Kudebayeva A, Turuspekova S, Lisnic V, Leone MA. The epidemiology of myasthenia gravis. J Med Life. 2021;14:7–16. 10.25122/jml-2020-0145 PubMed PMC

Dresser L, Wlodarski R, Rezania K, Soliven B. Myasthenia gravis: epidemiology, pathophysiology and clinical manifestations. J Clin Med. 2021;10:2235. 10.3390/jcm10112235 PubMed PMC

Gattellari M, Goumas C, Worthington JM. A national epidemiological study of myasthenia gravis in australia. Eur J Neurol. 2012;19:1413–20. 10.1111/j.1468-1331.2012.03698.x PubMed

Antonini G, Habetswallner F, Inghilleri M, Mantegazza R, Rodolico C, Saccà F, et al. Real world study on prevalence, treatment and economic burden of myasthenia gravis in Italy. Heliyon. 2023;9:e16367. 10.1016/j.heliyon.2023.e16367 PubMed PMC

Guptill JT, Marano A, Krueger A, Sanders DB. Cost analysis of myasthenia gravis from a large U.S. insurance database. Muscle Nerve. 2011;44:907–11. 10.1002/mus.22212 PubMed

Murai H, Hasebe M, Murata T, Utsugisawa K. Clinical burden and healthcare resource utilization associated with myasthenia gravis: assessments from a Japanese claims database. Clin Experimental Neuroimmunol. 2019;10:61–8. 10.1111/cen3.12495

Harris L, Graham S, MacLachlan S, Exuzides A, Jacob S. A retrospective longitudinal cohort study of the clinical burden in myasthenia gravis. BMC Neurol. 2022;22:172. 10.1186/s12883-022-02692-4 PubMed PMC

Mevius A, Jöres L, Biskup J, Heidbrede T, Mahic M, Wilke T, et al. Epidemiology and treatment of myasthenia gravis: a retrospective study using a large insurance claims dataset in Germany. Neuromuscul Disord. 2023;33:324–33. 10.1016/j.nmd.2023.02.002 PubMed

Pisc J, Ting A, Skornicki M, Sinno O, Lee E. Healthcare resource utilization, costs and treatment associated with myasthenia gravis exacerbations among patients with myasthenia gravis in the USA: a retrospective analysis of claims data. J Comp Eff Res. 2023;13:e230108. 10.57264/cer-2023-0108 PubMed PMC

Lehnerer S, Jacobi J, Schilling R, Grittner U, Marbin D, Gerischer L, et al. Burden of disease in myasthenia gravis: taking the patient’s perspective. J Neurol. 2022;269:3050–63. 10.1007/s00415-021-10891-1 PubMed PMC

Lee I, Leach JM, Aban I, McPherson T, Duda PW, Cutter G. One-year follow-up of disease burden and medication changes in patients with myasthenia gravis: from the MG patient registry. Muscle Nerve. 2022;66:411–20. 10.1002/mus.27659 PubMed PMC

Sonkar KK, Bhoi SK, Dubey D, Kalita J, Misra UK. Direct and indirect cost of myasthenia gravis: A prospective study from a tertiary care teaching hospital in India. J Clin Neurosci. 2017;38:114–7. 10.1016/j.jocn.2016.11.003 PubMed

Wartmann H, Hoffmann S, Ruck T, Nelke C, Deiters B, Volmer T, Incidence. Prevalence, hospitalization rates, and treatment patterns in myasthenia gravis: a 10-year real-world data analysis of German claims data. Neuroepidemiology. 2023;57:121–8. 10.1159/000529583 PubMed PMC

Ramsaroop T, Gelinas D, Kang SA, Govindarajan R. Analysis of length of stay and treatment emergent complications in hospitalized myasthenia gravis patients with exacerbation. BMC Neurol. 2023;23:12. 10.1186/s12883-022-02922-9 PubMed PMC

Guptill JT, Sharma BK, Marano A, Soucy A, Krueger A, Sanders DB. Estimated cost of treating myasthenia gravis in an insured U.S. population. Muscle Nerve. 2012;45:363–6. 10.1002/mus.22327 PubMed

Tambor M, Klich J, Domagała A. Financing healthcare in Central and Eastern European countries: how far are we from universal health coverage? Int J Environ Res Public Health. 2021;18:1382. 10.3390/ijerph18041382 PubMed PMC

Huang Y, Li Y, Pan H, Han L. Global, regional, and national burden of neurological disorders in 204 countries and territories worldwide. J Global Health. 2023;13:04160. 10.7189/jogh.13.04160 PubMed PMC

Sobieszczuk E, Napiórkowski Ł, Szczudlik P, Kostera-Pruszczyk A. Myasthenia gravis in Poland: National Healthcare Database Epidemiological Study. Neuroepidemiology. 2021;55:62–9. 10.1159/000512973 PubMed

Martinka I, Fulova M, Spalekova M, Spalek P. Epidemiology of myasthenia gravis in Slovakia in the years 1977–2015. Neuroepidemiology. 2018;50:153–9. 10.1159/000487886 PubMed

Cai Q, Zhang Q, Borsum J, Batista A, Kunovszki P, Isheden G, et al. EE403 direct and indirect costs among employed patients with myasthenia gravis in Sweden. Value Health. 2023;26:S133. 10.1016/j.jval.2023.03.704

Schepelmann K, Winter Y, Spottke AE, Claus D, Grothe C, Schröder R, et al. Socioeconomic burden of amyotrophic lateral sclerosis, myasthenia gravis and facioscapulohumeral muscular dystrophy. J Neurol. 2010;257:15–23. 10.1007/s00415-009-5256-6 PubMed

Landfeldt E, Pogoryelova O, Sejersen T, Zethraeus N, Breiner A, Lochmüller H. Economic costs of myasthenia gravis: a systematic review. PharmacoEconomics. 2020;38:715–28. 10.1007/s40273-020-00912-8 PubMed