Neuromyelitis optica spectrum disorder (NMOSD) is a rare, autoimmune condition characterized by unpredictable relapses affecting the optic nerves and spinal cord that can lead to blindness, paralysis, and premature death. Currently, evidence on the real-world economic cost of NMOSD is limited.
A retrospective observational matched-cohort analysis was conducted to characterize annual healthcare utilization and expenditure attributed to NMOSD in US clinical practice.
Data from the IQVIA PharMetrics Plus Healthcare Claims Database were used to identify adults who had evidence of NMOSD (≥1 inpatient diagnosis or ≥2 outpatient diagnoses) between 2013 and 2018 and a comparator group of patients without NMOSD who were matched on age, sex, geographic region, and insurance type. All-cause healthcare utilization and expenditure (2018 US dollars) were calculated for the matched cohorts and annualized to adjust for differential follow-up periods (maximum 6 years), with 95% confidence intervals (CI) calculated via nonparametric bootstrapping. Outcomes were analyzed overall and by care setting, diagnosis, and drug therapy.
The study population included 1,363 patients with NMOSD who were matched 1:1 with comparator patients. The mean age was 45 years (standard deviation: 13 years), and 75% were female. Mean (95% CI) annualized all-cause healthcare expenditure was $60,599 ($52,112-$66,716) among patients with NMOSD versus $8,912 ($7,084-$10,727) among matched comparators. Mean (95% CI) annualized expenditure attributed to NMOSD was $51,687 ($43,820-$58,664), of which 49% was for inpatient care and 51% was for ambulatory services. Hospitalizations with a principal diagnosis of neuromyelitis optica, transverse myelitis, optic neuritis, or other NMOSD-related conditions accounted for 51% of the total attributed expenditure in the inpatient setting. Use of rituximab (33%) and immunoglobulin (6%) accounted for 39% of the attributed expenditure in the outpatient setting. Treatment for acute relapses was the largest, single cost category.
Findings of this large retrospective study indicate that annual healthcare expenditure attributed to NMOSD in US clinical practice is over $50,000 per patient. A considerable component of this expenditure is associated with relapse-related care, especially in the inpatient setting.