Costs and health-related quality of life in patients with NMO spectrum disorders and MOG-antibody-associated disease: CHANCE(NMO) study
Martin W. Hümmert, Louisa M. Schöppe, Judith Bellmann–Strobl, Nadja Siebert, Friedemann Paul, Ankelien Duchow, Hannah Pellkofer, Tania Kümpfel, Joachim Havla, Sven Jarius, Brigitte Wildemann, Achim Berthele, Florian Then Bergh, Marc Pawlitzki, Luisa Klotz, Ingo Kleiter, Martin Stangel, Stefan Gingele, Martin S. Weber, Juergen Faiss, Refik Pul, Annette O. Walter, Uwe K. Zettl, Makbule Şenel, Jan‐Patrick Stellmann, Vivien Häußler, Kerstin Hellwig, Ilya Ayzenberg, Orhan Aktaş, Marius Ringelstein, Olivia Schreiber‐Katz, Corinna Trebst
Abstract
OBJECTIVE: To evaluate costs and health-related quality of life (HRQoL) of neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein-antibody associated disease (MOGAD).MethodsIn this multicenter cross-sectional study, data on consumption of medical and non-medical resources and work ability were assessed via patient questionnaires. Costs were analyzed in EUR for 2018 from the societal perspective. HRQoL was captured by the EuroQoL EQ-5D-5L questionnaire. Clinical data were retrieved from the Neuromyelitis Optica Study Group (NEMOS) database. RESULTS: Two hundred twelve patients (80% women; median age 50 [19-83] years; median disease duration 7 [0-43] years; median Expanded Disability Status Scale [EDSS] 3.5 [0-8.5]; 66% Aquaporin-4 IgG, 22% MOG IgG positive, 12% double seronegative) were analyzed. The mean total annual per capita cost of illness accounted for EUR (Euro) 59 574 (95% CI 51 225 to 68 293; USD [United States dollars] 70 297, 95% CI 60 445 to 80 586), and the mean index value of the EQ-5D-5L was 0.693 (95% CI 0.65 to 0.73). The most important cost drivers were informal care costs (28% of total costs), indirect costs (23%) and drugs (16%), especially immunotherapeutics. Costs showed a positive correlation with disease severity (ρ=0.56, 95% CI 0.45 to 0.65); in the EDSS 6.5-8.5 subgroup the mean annual costs were EUR 129 687 (95% CI 101 946 to 160 336; USD 153 031, 95% CI 120 296 to 189 196). The HRQoL revealed a negative correlation to disease severity (ρ=-0.69, 95% CI -0.76 to -0.61); in the EDSS 6.5-8.5 subgroup the EQ-5D-5L mean index value was 0.195 (95% CI 0.13 to 0.28). Neither antibody status nor disease duration influenced the total annual costs or HRQoL. CONCLUSION: These German data from the era without approved preventive immunotherapies show enormous effects of the diseases on costs and quality of life. An early and cost-effective therapy should be provided to prevent long-term disability and preserve quality of life.