Direct economic burden of patients with autoimmune encephalitis in western China

Abstract

ObjectiveTo analyze the cost of autoimmune encephalitis (AE) in China for the first time.MethodsPatients who were newly diagnosed with antibody-positive AE (anti-NMDA receptor [NMDAR], anti-γ aminobutyric acid type B receptor [GABABR], antileucine-rich glioma-inactivated 1 [LGI1], and anticontactin-associated protein-2 [CASPR2]) at West China Medical Center between June 2012 and December 2018 were enrolled, and a cost-of-illness study was performed retrospectively. Data on clinical characteristics, costs, and utilization of sources were collected from questionnaires and the hospital information system.ResultsOf the 208 patients reviewed, the mean direct cost per patient was renminbi (RMB) 94,129 (United States dollars [USD] 14,219), with an average direct medical cost of RMB 88,373 (USD 13,349). The average inpatient cost per patients with AE was RMB 86,810 (USD 13,113). The direct nonmedical cost was much lower than the direct medical cost, averaging RMB 5,756 (USD 869). The direct cost of anti-LGI1/CASPR2 encephalitis was significantly lower than that of anti-NMDAR encephalitis and anti-GABABR encephalitis. The length of stay in the hospital was significantly associated with the direct cost.ConclusionsThe financial burden of AE is heavy for Chinese patients, and there are significant differences between different types of AE.

Direct economic burden of patients with tuberculous meningitis in western China

“…The LOS was significantly positively associated with total direct cost ( r = .835) in our study, in agreement with previous studies 26,40 . The ICU admission rate in our study (5.2%) was lower than that in our previous studies of autoimmune encephalitis (10.7%–12.6%) 26,41,42 . Additionally, only 35.1% of the patients in our cohort received the standard HRZE regimen, consistent with the study conducted among neurologists (42.7%) in India, 22 and 50.6% of the patients received other intensified regimens with levofloxacin or moxifloxacin in our study.…”

“…Previous studies 10 on TB showed a shorter LOS (11–22 days) and lower medical cost (RMB 3,678–7,215) than those among the patients with TBM in our study, which may be related to the additional neurological treatments and difficulty of diagnosis, especially for nondefinite TBM cases 8 . The LOS was significantly positively associated with total direct cost ( r = .835) in our study, in agreement with previous studies 26,40 . The ICU admission rate in our study (5.2%) was lower than that in our previous studies of autoimmune encephalitis (10.7%–12.6%) 26,41,42 .…”

“…In our study, the direct medical cost (93.9%) was much higher than the direct nonmedical cost, consistent with our recent studies on autoimmune encephalitis, 26 epilepsy, 27 and meningitis in children 28 . Nevertheless, opposite results were reported in previous economic studies on TB, 11,29 with a higher nonmedical cost proportion (accounting for 55.2% of the direct cost).…”

“…Poor outcomes were related to higher total direct costs and inpatient costs ( p < .0001), as the patients with poor outcomes had more serious conditions and higher ICU admission rates (16.2% vs. 1.7%, p = .002). The financial burden of multidrug‐resistant patients was greater since most second‐line antitubercular drugs, such as linezolid and cycloserine, are expensive, and similar conclusions were also reported in studies on TB 25,26 . Definite TBM (which indicates a higher microbial load), fever (which may lead to delayed diagnosis 4 ), coma, seizures, extracerebral TB, and hydrocephalus were risk factors contributing to poor outcomes 3,7,43 and may lead to additional consumption of medical services.…”

Clinical characteristics of optic neuritis phenotypes in a 3-year follow-up Chinese cohort

“…In contrast, the medications were stopped in most patients in the seronegative-ON group. The most widely used medication for recurrent prophylaxis in MOG-ON is MMF, which was shown to have good efficacy and tolerance in Chinese patients 20 . In contrast, Azathioprine, which is routinely used as the first-line immunosuppressive treatment for NMO in Western countries, is less commonly utilized in China due to its association with hepatic lesions.…”