Direct and indirect cost of myasthenia gravis: A prospective study from a tertiary care teaching hospital in India

Sonkar, Kamlesh Kumar; Bhoi, Sanjeev Kumar; Dubey, Deepanshu; Kalita, Jayantee; Misra, Usha Kant

doi:10.1016/j.jocn.2016.11.003

Cited by 17 publications

(20 citation statements)

References 9 publications

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“…An AChEI holiday may increase the sensitivity of the postsynaptic membrane and may be of benefit when the drug is restarted prior to extubation according to MC guidelines [23]. However, in the present review, a benefit was observed whether the drug was given during or prior to weaning or extubation of patients with MC.…”

Section: Discussioncontrasting

confidence: 58%

Acetylcholinesterase Inhibitors in Myasthenic Crisis: A Systematic Review of Observational Studies

Prado

Adiao

2021

Neurocrit Care

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Current myasthenia gravis guidelines recommend intravenous immunoglobulin or plasmapheresis and discontinuation of pyridostigmine during myasthenic crisis. However, intravenous immunoglobulin or plasmapheresis is expensive and frequently not available in developing countries. This study aims to summarize the evidence of giving an acetylcholinesterase inhibitor in myasthenic crisis. Medline, Embase, and Cochrane databases and references were searched for observational studies that determined the use of acetylcholinesterase inhibitor in myasthenic crisis. The eligibility criteria were as follows: population, patients with myasthenic crisis, intervention (acetylcholinesterase inhibitor administration), and outcome (clinical improvement and complications). In total, 106 studies were identified, 92 through database searching (after removing duplicates) and 14 through other sources. Only eight were analyzed in the present systematic review. In five, acetylcholinesterase inhibitor was given at the start of the crisis, whereas in the other three, acetylcholinesterase inhibitor was discontinued initially and then restarted prior to extubation. Two observational analytic studies and three case reports showed improvement in different outcome measures. In the other three, improvement of outcome measures was also observed. Overall, a small proportion of patients developed cardiac arrhythmia and pneumonia after administration of acetylcholinesterase inhibitor alone, although this was not statistically different compared with those subjected to plasmapheresis. In summary, continuous intravenous infusion of pyridostigmine or neostigmine can be a substitute for intravenous immunoglobulin or plasmapheresis if these are not available during crisis; however, caution should be observed because of the aforementioned possible complications.

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Section: Discussioncontrasting

confidence: 58%

Acetylcholinesterase Inhibitors in Myasthenic Crisis: A Systematic Review of Observational Studies

Prado

Adiao

2021

Neurocrit Care

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“…Currently, the improved diagnosis and treatment technology have decreased the death rate of MG significantly, from 40% to less than 5% [1,2]. However, almost all patients with MG need long-term treatment with expensive medication to control their clinical symptoms [3,4] and even the cost of symptomatic treatment is gradually increasing [5,6]. This rapid increase in health expenditure can deprive many patients of essential treatment because they cannot afford it [7].…”

Section: Introductionmentioning

confidence: 99%

Out-of-pocket expenses for myasthenia gravis patients in China: a study on patients insured by basic medical insurance in China, 2013–2015

Lin

Zhang

Fang

et al. 2020

Orphanet J Rare Dis

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Background: Myasthenia gravis is a rare autoimmune neuromuscular disorder. The disorder requires long-term use of expensive medication to control clinical symptoms. This study analyzed the change in trends of total medical expenses and out-of-pocket expenses for patients with myasthenia gravis and explored the factors influencing them. Methods: In this retrospective study, data were derived from a survey of medical service utilization for patients insured by the Urban Basic Medical Insurance in China from 2013 to 2015. The cost data of 3347 patients with myasthenia gravis were included in this study. The baseline characteristics and medical expenses for patients with myasthenia gravis were analyzed using a descriptive method. The difference and influencing factors of the out-ofpocket ratio were analyzed from both outpatient and inpatient expenses by using the quantile regression method. Results: The total expenses reimbursed by the Urban Basic Medicine Insurance for all patients with myasthenia gravis fell progressively from 73.1 to 58.7% during the study period. Patients' out-of-pocket expenses increased gradually, of which expenses within the scope of Basic Medicine Insurance increased from 14.7 to 22.6% and expenses outside of the Basic Medicine Insurance scope increased from 12.6 to 18.7%. Moreover, the panel quantile results showed a positive correlation between the year of receiving treatment and the out-of-pocket ratio. In addition to the 25th quantile of the out-of-pocket ratio among outpatients with myasthenia gravis, there were significant differences in medical insurance and medical institution among all the other quantiles. Significant regional differences were found in all quantiles of the out-of-pocket ratio, except for the 75th quantile among inpatients. Lastly, age had a negative effect on inpatients with myasthenia gravis across all quantiles, but not on outpatients. Conclusions: From 2013 to 2015, patients with myasthenia gravis's out-of-pocket expenses increased progressively. Moreover, the individual out-of-pocket ratio was affected by the year, medical insurance, medical institution, region, and age. The current medical insurance policy for the general public has a low ability to cater for patients with myasthenia gravis.

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“…Cholinesterase inhibitors, glucocorticoids, and immunosuppressants (e.g., azathioprine) are often used as first‐line treatments for newly diagnosed MG patients or for long‐term management of patients with mild or localized symptoms, such as ptosis and dysarthria . However, one‐third of MG patients still have difficulty controlling their conditions and experience worsening of symptoms even with these first‐line treatments . In addition, the long‐term use of immunosuppressive agents, such as glucocorticosteroids and azathioprine, often leads to significant side effects (e.g., diabetes, obesity, hypertension, steroid dependence, liver dysfunction, and myelosuppression).…”

Section: Introductionmentioning

confidence: 99%

Myasthenia gravis and specific immunotherapy: monoclonal antibodies

Cai

et al. 2019

Annals of the New York Academy of Sciences

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Myasthenia gravis (MG) is an acquired autoimmune disease affecting the postsynaptic membrane of neuromuscular junctions and characterized by antibody-mediated T cell dependence and complement involvement. Cholinesterase inhibitors (e.g., pyridostigmine bromide), glucocorticoids, and azathioprine are currently recommended as firstline treatments for MG, though they have limitations, including potential toxicity and ineffectiveness in patients with refractory MG. In recent years, owing to an increasing understanding of MG pathogenesis the development and execution of clinical trials with novel biologics, including monoclonal antibodies (mAbs) that have demonstrated higher safety and more specificity, provide new opportunities for the treatment of MG. In this article, we review recent advances in MG pathogenesis and the mAbs that have been used for target-specific MG therapy.

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Direct and indirect cost of myasthenia gravis: A prospective study from a tertiary care teaching hospital in India

Cited by 17 publications

References 9 publications

Acetylcholinesterase Inhibitors in Myasthenic Crisis: A Systematic Review of Observational Studies

Acetylcholinesterase Inhibitors in Myasthenic Crisis: A Systematic Review of Observational Studies

Out-of-pocket expenses for myasthenia gravis patients in China: a study on patients insured by basic medical insurance in China, 2013–2015

Myasthenia gravis and specific immunotherapy: monoclonal antibodies

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