Economic Burden of Generalized Myasthenia Gravis (gMG) in Latin America (LA): A Microcosting Analysis of Direct Medical Costs (DMCs)
Author(s)
Gabriela Kanevsky, MD1, Marcelo Rugiero, MD2, Edmar Zanoteli, MD3, Cesar Augusto Forero Botero, MD4, Valeria Boers Trilles, MPhil5, Steven Vargas-Cañas, MD6, Renato Watanabe de Oliveira, MSc, PharmD7, Ligia Cohelo, MD8, William Murasawa, MD9.
1Johnson & Johnson, Argentina, Argentina, 2Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 3HCFMUSP, São Paulo, Brazil, 4Fundación Santa Fe de Bogota, Fundación Santa Fe de Bogota, Colombia, 5Trinity Life Sciences, San Francisco, CA, USA, 6Instituto Nacional de Neurología y Neurocirugía, Mexico, Mexico, 7Janssen, São Paulo, Brazil, 8Janssen - Johnson&Johnson, Sao Paulo, Brazil, 9Trinity Life Science, San Francisco, CA, USA.
1Johnson & Johnson, Argentina, Argentina, 2Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 3HCFMUSP, São Paulo, Brazil, 4Fundación Santa Fe de Bogota, Fundación Santa Fe de Bogota, Colombia, 5Trinity Life Sciences, San Francisco, CA, USA, 6Instituto Nacional de Neurología y Neurocirugía, Mexico, Mexico, 7Janssen, São Paulo, Brazil, 8Janssen - Johnson&Johnson, Sao Paulo, Brazil, 9Trinity Life Science, San Francisco, CA, USA.
OBJECTIVES: We sought to characterize the economic burden of gMG in LA through the estimation of DMCs across lines of therapy (LOT).
METHODS: We conducted a targeted literature review and a modified Delphi panel, with 7 medical experts in each of the 4 countries (Argentina, Brazil, Colombia, and Mexico), to collect data and validate assumptions on the epidemiology, treatment profile, HCRU, and adverse events. We calculated costs by multiplying official unit costs and the number and frequency of each outcome of interest.
RESULTS: Initial treatments include pyridostigmine, corticosteroids, and nonsteroidal immunosuppressives while off label therapies like rituximab and intravenous immunoglobulin (IVIg), and C5 inhibitors are reserved as later LOTs across countries. Similarly, exacerbation and crisis frequencies generally increased with later LOT. Hospitalization rates during exacerbations ranged from 33%-66%, lasting 6-10 days, with 13%-31% requiring intensive care, on average. In gMG crises, hospitalization rates were higher (33%-66%), averaging 9-13 days, and intensive care use ranged from 74%-100%. For IVIg requirement, estimates ranged from 14%-44% of patients for exacerbations and 12%-52% for crises, while PLEX ranged from 11%-44% for exacerbations and 27%-75% for crises. Patients in LOT1 and LOT2 constituted 30%-45% and 39%-44%, respectively, predominantly in the public sector. Estimated total costs per country ranged from USD 10.7 M to 122.7 M. Costs were higher in LOT2 (USD 85.4 M) and LOT3 (USD 71.5 M) than in LOT1 (USD 31.3 M) and LOT4 (USD 52.7 M) in the 4 countries combined. Costs per patient increased from 4 to 20 times, depending on the setting and country, as patients move from LOT1 to LOT4. Treatment for gMG constituted the largest share of DMCs.
CONCLUSIONS: Patients with gMG in LA are moving across treatments that may suggest limited disease control and is burdensome for the healthcare system.
METHODS: We conducted a targeted literature review and a modified Delphi panel, with 7 medical experts in each of the 4 countries (Argentina, Brazil, Colombia, and Mexico), to collect data and validate assumptions on the epidemiology, treatment profile, HCRU, and adverse events. We calculated costs by multiplying official unit costs and the number and frequency of each outcome of interest.
RESULTS: Initial treatments include pyridostigmine, corticosteroids, and nonsteroidal immunosuppressives while off label therapies like rituximab and intravenous immunoglobulin (IVIg), and C5 inhibitors are reserved as later LOTs across countries. Similarly, exacerbation and crisis frequencies generally increased with later LOT. Hospitalization rates during exacerbations ranged from 33%-66%, lasting 6-10 days, with 13%-31% requiring intensive care, on average. In gMG crises, hospitalization rates were higher (33%-66%), averaging 9-13 days, and intensive care use ranged from 74%-100%. For IVIg requirement, estimates ranged from 14%-44% of patients for exacerbations and 12%-52% for crises, while PLEX ranged from 11%-44% for exacerbations and 27%-75% for crises. Patients in LOT1 and LOT2 constituted 30%-45% and 39%-44%, respectively, predominantly in the public sector. Estimated total costs per country ranged from USD 10.7 M to 122.7 M. Costs were higher in LOT2 (USD 85.4 M) and LOT3 (USD 71.5 M) than in LOT1 (USD 31.3 M) and LOT4 (USD 52.7 M) in the 4 countries combined. Costs per patient increased from 4 to 20 times, depending on the setting and country, as patients move from LOT1 to LOT4. Treatment for gMG constituted the largest share of DMCs.
CONCLUSIONS: Patients with gMG in LA are moving across treatments that may suggest limited disease control and is burdensome for the healthcare system.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE361
Topic
Economic Evaluation, Health Service Delivery & Process of Care
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Neurological Disorders, No Additional Disease & Conditions/Specialized Treatment Areas