OBJECTIVES: Myasthenia gravis (MG) is a rare autoimmune disorder of the peripheral motor system. The objective was to assess in a real-world setting, treatment patterns, resource use and associated costs in the management of MG patients treated with plasma exchange (PE) therapy in Belgium. Intravenous immunoglobulin treatment is not reimbursed for MG in Belgium. METHODS: A retrospective patient chart review was performed to explore healthcare resource utilization. Study sample consisted of adult MG patients treated at least once with PE before 15/05/2013. Data on demographics, disease characteristics and management were collected across three health states: complete remission/asymptomatic (A), myasthenic crisis (MC), and non-complete remission (non-CR). Patients could transition from one health state to another over time. All outcomes were expressed per person year (PY). Direct costs were calculated using the Belgian public payer’s perspective (RIZIV/INAMI) and patient’s perspective (PP), using unit costs of 2015 (€). RESULTS: One centre participated in this study. Sixty-two MG patients (mean age 56 years; 32 females) were retained for analysis, with a follow-up period ranging between 21 days to 19.3 years. In total, there were 389.21 PY in this study. Seventeen MC were recorded in 13 patients (0.044/PY). 74 % of study time was spent in non-CR (271.12 days/PY). 28 patients remained in non-CR throughout study period. Ten deaths were observed; five were related to MG. Patients had 4.09 PE sessions/PY and were hospitalized for 7.91 days/PY. Main reason for hospitalization was worsening of MG with/without PE. Overall cost/PY was €5,465.52 from RIZIV/INAMI perspective and €259.72 from PP. Cost was mainly driven by hospitalizations (€4,091.86/PY from RIZIV/INAMI and €137.51/PY from PP) and non-CR health state (€4,698.80/PY from RIZIV/INAMI and €205.39/PY from PP). CONCLUSIONS: A significant unmet medical need is observed across MG patients, as most studied patients remained in non-remission throughout study period.