Economic Impact of Relapses in Patients with Neuromyelitis Optica Spectrum Disorder (NMOSD): A Systematic Literature Review

OBJECTIVES: NMOSD is an immune-mediated demyelinating disease of the central nervous system characterized by relatively frequent relapses and risk of disability accumulation, particularly with respect to vision and mobility. While several NMOSD studies reported costs and healthcare resource utilization (HCRU), much remains unknown concerning the influence of relapses on economic outcomes. This systematic literature review aims to comprehensively assess the economic burden in NMOSD, with a focus on the impact of NMOSD relapses.

METHODS: An SLR was conducted following Cochrane guidelines to identify studies reporting costs and HCRU in NMOSD published between January 2010 and May 2023 in MEDLINE, Embase, NHS Economic Evaluations Database, and Econlit. Health technology assessments and abstracts from relevant conferences published in the past three years were manually searched.

RESULTS: Among 28 included studies, six reported cost and HCRU associated with NMOSD relapses. Total annual costs were up to 4.4-fold higher in patients with at least one relapse compared to patients without attacks. Inpatient, outpatient, and comorbidities-related expenditures were up to 2.3-fold, 1.6-fold, and 2.0-fold higher, respectively, for patients who had relapses compared with the overall NMOSD population. Furthermore, compared with both the overall population and patients without relapses, active NMOSD (≥2 relapses in 12 months) required more emergency room visits (60% vs 35% and 69% vs 45% of patients, respectively), more hospitalizations (43-54% vs 22-27% and 64% vs 7% of patients, respectively), and longer annual inpatient length of stay (24.8-26.9 days vs 11.8-18.0 days and 4.1 vs 0.2 days, respectively). Outpatient visits were significantly higher among patients with relapses than those without relapses (97% vs 80%).

CONCLUSIONS: A considerable component of the economic burden in NMOSD is associated with care related to relapses, especially in the inpatient setting. Effective and continuous management of NMOSD to prevent relapses is necessary to mitigate healthcare resource utilization and economic burden of disease.