OBJECTIVES: Myasthenia Gravis (MG) is a chronic neuromuscular autoimmune disease that affects the use of muscles. The body produces autoantibodies that block the regular function of the muscles and nerves. About 10 to 20 percent of MG patients experience at least one MG crisis and it’s a life-threatening condition. This complication of MG characterized by worsening of muscle weakness resulting in respiratory failure requiring intubation or noninvasive ventilation. Immunomodulating therapies such as therapeutic plasma exchange (TPE) or intravenous immunoglobulin (IVIg) is prescribe in crisis management. This study examined the cost MG crisis treatments in a public tertiary hospital.

METHODS: Inpatient resource utilization and cost data was obtained from relevant department in Hospital Seberang Jaya (HSJ). A cost minimization analysis comparing TPE and IVIg was performed. The model was developed in Microsoft Excel spreadsheet using micro-costing approach. The model assumed equivalent clinical effectiveness and safety profile for both therapies.

RESULTS: Every year on average, a total of 5 MG crisis patients received treatment at HSJ. The estimated overall cost of TPE and IVIg treatment is RM 82,924 (USD 19,122) and RM 95,724 (USD 22,056) for each MG crisis episode. In this cost calculation, we had 1 patient treated with TPE and 4 patients with IVIg. Further analysis showed that each addition of TPE patient, the potential savings increased from 23.8% (n=2) to 44% (n=8). Failure to test for MuSK antibodies prior to initiation of IVIg treatment will increase treatment cost by RM 11,487 (USD 2,647) for each MuSK positive patient.

CONCLUSIONS: The economic evaluation of these therapies showed that TPE is less costly than IVIg. The estimated cost savings enable hospital to re-invest in new medicines or medical technology as well as widening patient access.