Economic burden and quality of life of IgG4-related disease in China: A comparative analysis of three treatment regimens
Yifei Wang, Jialing Jiang, Yuxue Nie, Jingna Li, Jialei Zhang, Qinhuan Luo, Xinli Yang, Nianyi Zhang, Shuo Liu, Jueming Lei, Jiaxin Zhou, Yunyun Fei, Linyi Peng, Wen ZhangAbstract
Background and Objectives
IgG4-related disease (IgG4-RD) is a chronic fibroinflammatory disorder requiring prolonged treatment, placing substantial financial burden on patients. This study compares the direct medical costs of three treatment regimens—glucocorticoid (GC), GC combined with Mycophenolate mofetil (MMF), and rituximab (RTX) —and evaluates the patients’ health-related quality of life (HR-QoL) using the EuroQol 5-Dimension 5-Level scale (EQ-5D-5 L) to assess cost-effectiveness.
Methods
Our retrospective cohort study consecutively distributed EQ-5D-5 L questionnaires to treatment-naïve IgG4-RD outpatients. Patients formed three cohorts: 30 with GC, 30 with GC+MMF, and 20 with RTX. Patients on other regimens were excluded. HR-QoL was assessed using EQ-5D-5 L questionnaires and visual analog scales. Quality-adjusted life years (QALYs) were calculated, and incremental cost-effectiveness ratios were computed. Probabilistic sensitivity analysis with Monte Carlo simulations evaluated cost-effectiveness across willingness-to-pay thresholds.
Results
First-year treatment costs were $1284.53 for GC, $2090.96 for GC+MMF, and $6175.97 for RTX. RTX group demonstrated the lowest relapse rate. No significant differences were observed in HR-QoL scores among groups, though visual analog scale (VAS) scores favored GC over GC+MMF. Median incremental cost-effectiveness ratios of probabilistic sensitivity analysis were $13,310/QALY for RTX versus GC and $17,412/QALY for RTX versus GC+MMF. GC demonstrated highest cost-effectiveness probability at willingness-to-pay thresholds below $15,000/QALY. Inverse probability of treatment weighting analysis confirmed these findings’ robustness after controlling for selection bias.
Conclusions
While RTX offers superior efficacy with lowest relapse rates, its high price leads to limited usage in China. GC-based regimens provide reasonable outcomes at lower costs, making GC or GC+MMF more economical choices.