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Plasma Exchange versus Intravenous Immunoglobulin for Myasthenia Gravis Crisis: An Acute Hospital Cost Comparison Study

Heatwole, Chad MD, MS-CI*; Johnson, Nicholas MD*; Holloway, Robert MD, MPH*; Noyes, Katia PhD

Journal of Clinical Neuromuscular Disease: December 2011 - Volume 13 - Issue 2 - p 85-94
doi: 10.1097/CND.0b013e31822c34dd
Original Article

Objective: To compare the short-term financial costs of treating a patient in myasthenia gravis crisis with intravenous immunoglobulin (IVIG) versus plasma exchange.

Methods: An itemized comparative cost-minimization analysis of IVIG versus plasma exchange for myasthenia gravis crisis was performed. Calculations were based on each therapy's implementation cost, associated hospitalization times, and predicted cost to treat known complications. A cost superiority determination was proposed based on the total cost profile of each therapy.

Results: The difference in total cost favored IVIG over plasma exchange with an average savings of $22,326 per patient. Sensitivity analysis demonstrated that overall costs are highly dependent on IVIG dosing, hospital lengths of stay, and the number of plasma exchange days required.

Conclusions: The use of IVIG for myasthenia gravis crisis may be a short-term cost minimizing therapy compared with plasma exchange. Additional prospective studies are required to evaluate the extended cost profile and efficacy of these therapies.

Supplemental Digital Content is Available in the Text.

From the Departments of *Neurology and †Community and Preventative Medicine, University of Rochester, Rochester, NY.

C.H. receives grant support through the National Institutes of Health (NIH) (1K23AR055947), the New York State Empire Clinical Research Investigator Program (ECRIP), and the Muscular Dystrophy Association. C.H. was also the recipient of a previous Clinical and Translational Science Institute Award and NIH Experimental Therapeutics for Neuromuscular Diseases Grant through the University of Rochester.

Robert Holloway: is an Associate Editor, Neurology Today, and a Consultant, Milliman Guideline, review neurology guidelines.

None of the authors have conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Reprints: Chad Heatwole, MD, MS-CI, Neuromuscular Disease Center, University of Rochester, 601 Elmwood Avenue, Box 673, Rochester, NY 14642 (e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.