B.05 Optimizing IVIg utilization for neuromuscular disease in BC: high user project

Abstract

Background: In British Columbia, neuromuscular disease accounts for 31% of IVIg use, at a cost of $10.1 M. In addition to the new screening pathway, the BC Neuromuscular IVIg Program developed the Chronic High User Project to identify areas for improvement in utilization. Methods: Utilizing CTR data, all patients on IVIg maintenance therapy for approved neuromuscular conditions between April 1, 2013 and March 31, 2014 were identified. Patients receiving higher than usual IVIG treatments (CIDP and MG >1110 grams/year, MMNCB > 1400 grams/year) were evaluated. Following panel review, utilization data was compared with a second cohort (2014 to 2015) to determine impact. Following review, appropriateness of treatment was determined by consensus from a 3-member panel, and recommendations were made. Results: Of 377 patients, 38 “High Users” were identified. 29 cases were determined to be appropriate; 9 were not. There was a reduction in mean grams/episode in CIDP (1135g to 990g) and MG (1099 g to 1022g) between cohorts. The mean grams/episode for MMNCB did not change. Conclusions: In specific cases, the IVIg High User Program identified patients in whom the treatment could be optimized. However, the vast majority of use of IVIg for Neuromuscular Disease in BC is appropriate, including in patients requiring higher that “usual” doses.