Intravenous Immunoglobulin versus Plasma Exchange in the Management of Patients with Myasthenia Gravis: A Cost-Minimization Analysis (P1.344)
Bibliographic record
Abstract
Background: Myasthenia gravis (MG) exacerbations may be treated with intravenous immunoglobulin (IVIg) or plasma exchange (PLEX), which have equivalent effectiveness. Nonetheless, further investigations are needed to determine the economic impact of those treatment options in the management of MG exacerbations. Objectives: This cost-minimization analysis was carried out to compare IVIg with PLEX for treatment of patients with MG exacerbation. Methods: This study combined the Ontario-based health cost data with clinical data from a randomized clinical trial (Neurology, 2011). Analyses were undertaken from the perspective of a public health care insurer and from the perspective of a tertiary university hospital payer in Toronto, Canada. Results: This study included 32 patients who received IVIg and 38 patients treated with PLEX from 2007 to 2010. Both patient groups were statistically comparable regarding demographics, disease characteristics, and severity prior to treatment. PLEX was less costly than IVIg among patients with body mass index (BMI) >15.7 Kg/m², from the perspective of a public health care insurer (P<0.0001). However, PLEX was more costly than IVIg from the perspective of the hospital payer when the costs of blood products were excluded (P<0.0001). Conclusions: The results of this cost-minimization analysis indicate that PLEX treatment may be a short-term cost-minimizing therapy for patients with MG exacerbation when compared with IVIg treatment, from the perspective of a public health care insurer. However, IVIg could be considered the more cost-minimizing therapy for individuals with BMI of 15.7 Kg/m² or lower (i.e. body weight of 43.26 Kg or less in our cohort of patients) when compared to PLEX. In addition, when the costs of blood products are absorbed by a third party, the hospital administration may see the IVIg therapy as a more financially attractive alternative for treatment of patients with MG exacerbation when compared to treatment with PLEX.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.006 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".