Barriers to access and unmet needs to neuromyelitis optica spectrum disorders care in an Argentinean cohort

• Published in: Multiple sclerosis and related disorders 2023-02, Vol.70, p.104485-104485, Article 104485
• Main Authors: Tkachuk, Verónica, Balbuena Aguirre, María Eugenia, Alonso, Ricardo, Barboza, Andrés, Liwacki, Susana del Valle, Mainella, Carolina, Rojas, Juan I., Silva, Berenice Anabel, Tavolini, Darío, Zanga, Gisela, López, Pablo, Delgado Garcia, Guillermo, Carnero Contentti, Edgar
• Format: Article
• Language: English
• Subjects: Access; Aquaporin 4; Argentina; Autoantibodies; Cross-Sectional Studies; Diagnosis; Female; Health care resource utilization; Humans; Latin America; Magnetic Resonance Imaging; Neuromyelitis Optica; Neuromyelitis optica spectrum disorder; Treatment
• ISSN: 2211-0348; 2211-0356
• DOI: 10.1016/j.msard.2022.104485

•NMOSD is associated with increased health care utilization and with a significant financial burden.•100 NMOSD patients from Argentina were included and AQP4-Ab and/or MOG-Ab testing were requested in 91% of patients.•Health insurance covered AQP4-Ab and/or MOG-Ab test partially in 15% of cases, but 33% of patients paid it in full of their own pocket.•Private insurance (OR=3.84, p=0.01) was the only factor independently associated with appropriate access to long-term NMOSD-specific medications. Neuromyelitis optica spectrum disorder (NMOSD) is a rare but severe neuroimmunological condition associated with a significant financial burden. NMOSD is also associated with increased health care utilization, including neurology outpatient visits, magnetic resonance imaging (MRI) use, long-term medication, among others. We aimed to evaluate real-world patient experiences in access to care and NMOSD burden in an Argentinean cohort. This cross-sectional study used a self-administered survey and was conducted in Argentina (2022). Patients with NMOSD were divided into three groups: private health insurance (PHI), social health insurance (SHI), and public health insurance (PHI, Ministry of Public Health). Differences in access and health care barriers were assessed. One hundred patients with NMOSD (74 women) with a mean age at diagnosis of 38.7 years were included. Their EDSS was 2.8 and they were followed for 5.2 years. Of them, 51%, 11%, and 13% were employed (full-time: 57.5%), currently unemployed and retired by NMOSD, respectively. 55% of them visited between 2-3 specialists before NMOSD diagnosis. Aquaporin-4-antibody and/or myelin oligodendrocyte glycoprotein-antibody testing was requested in 91% (health insurance covered this partially in 15.3% and 32.9% of the time the test was entirely paid by patient/family). Patients with NMOSD receiving private medical care reported greater access to MRI, outpatient visits, and fewer issues to obtain NMOSD medications compared to those treated at public institutions. A longer mean time to MRI and neurology visit was found in the PHI group when compared with the other two subgroups. Regression analysis showed that private insurance (OR=3.84, p=0.01) was the only independent factor associated with appropriate access to NMOSD medications in Argentina. These findings suggest that barriers to access and utilization of NMOSD care services in Argentina are common. NMOSD patients experienced problems to receive NMOSD medication pro