Comparison of treatment efficacy and cost-effectiveness of rituximab and oral agents among patients with neuromyelitis optica spectrum disorders: a population-based cohort study.

Abstract

Background: Rituximab (RTX) is a well-known effective treatment for neuromyelitis optica spectrum disorder (NMOSD).

Aims: To investigate the effectiveness of RTX treatment in patients with NMOSD and compared medical expenses between RTX and other oral agents.

Methods: Using data from the National Health Insurance System database (2010-2021), we compared the time to the first relapse and medical expenses after each medication between groups with RTX and oral agents. Also, we analyzed the association between the level of disability and the type of drugs.

Results: A total of 899 patients were included, and they were divided into two groups according to the type of treatment. The group treated with RTX had a lower risk of relapse than those treated with other oral agents (hazard ratio, 0.479, p < 0.001). Regarding medical expenses, the increase in total medical costs was associated with the use of RTX and the number of relapses. The increase in medical costs was higher in cases with increased disability owing to NMOSD after adjustment for the number of relapses.

Conclusion: In comparison to other oral agents, RTX showed a favorable treatment effect. It is also relatively cost-effective, considering the change in disability in a large-scale real-world nationwide study.