The Fiscal Consequences for the Canadian Government of Efgartigimod in the Treatment of Generalized Myasthenia Gravis

<b>Background:</b> Generalized myasthenia gravis (gMG) severely impacts activities of daily living. Productivity losses and the need for care can impact household finances and consequently government public accounts. This study adopts a governmental perspective framework to assess the fiscal consequences of treating gMG that is inadequately controlled by standard therapy, beyond healthcare costs. Savings in tax revenue loss and benefit payments are considered. <b>Objectives:</b> To value the fiscal consequences of treating adults with acetylcholine receptor-antibody positive (AChR-Ab+) gMG with efgartigimod vs current treatments. The lifetime impact on people living with gMG and their caregivers is considered from the perspective of Canada's public accounts. <b>Methods:</b> A lifetime Markov cohort simulation following adults with gMG according to their Activities of Daily Living (MG-ADL) score was linked to labor and fiscal stages of both patients and care- givers. Based on the MyRealWorld MG study, MG-ADL scores defined the labor market characteristics of both individuals with gMG and their caregivers. National statistics data on sex- and age-specific labor outcomes were used to model patients with minimal symptoms. Benefit payments and tax revenue losses attributable to gMG were estimated and valued according to national official sources. Public healthcare costs were included. The difference between efgartigimod and current treatments was assessed by discounted lifetime incremental fiscal consequences. Sensitivity analyses were applied to the fiscal parameters. <b>Results:</b> Without active treatments, the lifetime fiscal burden associated with individuals with gMG and their caregivers was estimated at CAD <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mn>1.24</mml:mn> <mml:mi>m</mml:mi> <mml:mi>i</mml:mi> <mml:mi>l</mml:mi> <mml:mi>l</mml:mi> <mml:mi>i</mml:mi> <mml:mi>o</mml:mi> <mml:mi>n</mml:mi> <mml:mi>i</mml:mi> <mml:mi>n</mml:mi> <mml:mi>g</mml:mi> <mml:mi>o</mml:mi> <mml:mi>v</mml:mi> <mml:mi>e</mml:mi> <mml:mi>r</mml:mi> <mml:mi>n</mml:mi> <mml:mi>m</mml:mi> <mml:mi>e</mml:mi> <mml:mi>n</mml:mi> <mml:mi>t</mml:mi> <mml:mi>e</mml:mi> <mml:mi>x</mml:mi> <mml:mi>p</mml:mi> <mml:mi>e</mml:mi> <mml:mi>n</mml:mi> <mml:mi>d</mml:mi> <mml:mi>i</mml:mi> <mml:mi>t</mml:mi> <mml:mi>u</mml:mi> <mml:mi>r</mml:mi> <mml:mi>e</mml:mi> <mml:mi>s</mml:mi> <mml:mo>.</mml:mo> <mml:mi>C</mml:mi> <mml:mi>o</mml:mi> <mml:mi>m</mml:mi> <mml:mi>p</mml:mi> <mml:mi>a</mml:mi> <mml:mi>r</mml:mi> <mml:mi>e</mml:mi> <mml:mi>d</mml:mi> <mml:mi>w</mml:mi> <mml:mi>i</mml:mi> <mml:mi>t</mml:mi> <mml:mi>h</mml:mi> <mml:mi>t</mml:mi> <mml:mi>h</mml:mi> <mml:mi>e</mml:mi> <mml:mi>c</mml:mi> <mml:mi>u</mml:mi> <mml:mi>r</mml:mi> <mml:mi>r</mml:mi> <mml:mi>e</mml:mi> <mml:mi>n</mml:mi> <mml:mi>t</mml:mi> <mml:mi>w</mml:mi> <mml:mi>e</mml:mi> <mml:mi>i</mml:mi> <mml:mi>g</mml:mi> <mml:mi>h</mml:mi> <mml:mi>t</mml:mi> <mml:mi>e</mml:mi> <mml:mi>d</mml:mi> <mml:mi>b</mml:mi> <mml:mi>u</mml:mi> <mml:mi>n</mml:mi> <mml:mi>d</mml:mi> <mml:mi>l</mml:mi> <mml:mi>e</mml:mi> <mml:mi>o</mml:mi> <mml:mi>f</mml:mi> <mml:mi>t</mml:mi> <mml:mi>r</mml:mi> <mml:mi>e</mml:mi> <mml:mi>a</mml:mi> <mml:mi>t</mml:mi> <mml:mi>m</mml:mi> <mml:mi>e</mml:mi> <mml:mi>n</mml:mi> <mml:mi>t</mml:mi> <mml:mi>s</mml:mi> <mml:mi>i</mml:mi> <mml:mi>n</mml:mi> <mml:mi>C</mml:mi> <mml:mi>a</mml:mi> <mml:mi>n</mml:mi> <mml:mi>a</mml:mi> <mml:mi>d</mml:mi> <mml:mi>a</mml:mi> <mml:mo>,</mml:mo> <mml:mi>e</mml:mi> <mml:mi>f</mml:mi> <mml:mi>g</mml:mi> <mml:mi>a</mml:mi> <mml:mi>r</mml:mi> <mml:mi>t</mml:mi> <mml:mi>i</mml:mi> <mml:mi>g</mml:mi> <mml:mi>i</mml:mi> <mml:mi>m</mml:mi> <mml:mi>o</mml:mi> <mml:mi>d</mml:mi> <mml:mi>w</mml:mi> <mml:mi>a</mml:mi> <mml:mi>s</mml:mi> <mml:mi>e</mml:mi> <mml:mi>s</mml:mi> <mml:mi>t</mml:mi> <mml:mi>i</mml:mi> <mml:mi>m</mml:mi> <mml:mi>a</mml:mi> <mml:mi>t</mml:mi> <mml:mi>e</mml:mi> <mml:mi>d</mml:mi> <mml:mi>t</mml:mi> <mml:mi>o</mml:mi> <mml:mi>s</mml:mi> <mml:mi>a</mml:mi> <mml:mi>v</mml:mi> <mml:mi>e</mml:mi> <mml:mi>C</mml:mi> <mml:mi>A</mml:mi> <mml:mi>D</mml:mi></mml:math> 458 754 per treated adult. Results were sensitive to the distribution of the bundle of treatments. <b>Discussion:</b> Beyond healthcare costs, gMG severely impacts productivity and governmental accounts. Decision-makers should be provided evidence of fiscal consequences when assessing healthcare technologies. The public sector in Canada was estimated to have a return of CAD <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mn>1.58</mml:mn> <mml:mi>p</mml:mi> <mml:mi>e</mml:mi> <mml:mi>r</mml:mi> <mml:mi>e</mml:mi> <mml:mi>v</mml:mi> <mml:mi>e</mml:mi> <mml:mi>r</mml:mi> <mml:mi>y</mml:mi> <mml:mi>C</mml:mi> <mml:mi>A</mml:mi> <mml:mi>D</mml:mi></mml:math> 1 spent on efgartigimod for people with gMG compared with the current bundle of treatments. <b>Conclusions:</b> Improving health outcomes and reducing the need for informal caregivers benefits those affected by gMG and governmental accounts.