Abstract
Primary immunodeficiency diseases (PID), which are comprised of over 400 genetic disorders, occur when a component of the immune system is diminished or dysfunctional. Patients with PID who require immunoglobulin (IG) replacement therapy receive intravenous IG (IVIG) or subcutaneous IG (SCIG), each of which provides equivalent efficacy. We developed a cost-minimization model to evaluate costs of IVIG versus SCIG from the Spanish National Healthcare System perspective. The base case modeled the annual cost per patient of IVIG and SCIG for the mean doses (per current expert clinical practice) over 1 year in terms of direct (drug and administration) and indirect (lost productivity for adults and parents/guardians of pediatric patients) costs. It was assumed that all IVIG infusions were administered in a day hospital, and 95% of SCIG infusions were administered at home. Drug costs were calculated from ex-factory prices obtained from local databases minus the mandatory deduction. Costs were valued on 2018 euros. The annual modeled costs were €4,266 lower for patients with PID who received SCIG (total €14,466) compared with those who received IVIG (total €18,732). The two largest contributors were differences in annual IG costs as a function of dosage (– €1,927) and hospital administration costs (– €2,688). However, SCIG incurred training costs for home administration (€695). Sensitivity analyses for two dose-rounding scenarios were consistent with the base case. Our model suggests that SCIG may be a cost-saving alternative to IVIG for patients with PID in Spain.
Highlights
Primary immunodeficiency diseases (PID) occur when a component of the immune system is diminished or dysfunctional and may be caused by over 400 identified genetic disorders [1]
In the base case (Table 2), the annual cost of subcutaneous immunoglobulin (SCIG) treatment per average patient was lower than the intravenous immunoglobulin (IVIG) cost by €4266.17 (22.8%)
Hospital administration (∆: – €2688.03) and IG costs as a function of dosage (∆: – €1927.47) were the main factors affecting the difference in direct costs (Online Resource 5)
Summary
Primary immunodeficiency diseases (PID) occur when a component of the immune system is diminished or dysfunctional and may be caused by over 400 identified genetic disorders [1]. The prevalence of PID in Spain is estimated to be at least 4.9 per 100,000 individuals [4]. Because this calculation is based on registry data, the actual prevalence is likely to be higher. Various IGRT products are available in subcutaneous immunoglobulin (SCIG), facilitated SCIG (fSCIG) and intravenous immunoglobulin (IVIG) formulations in Spain. IVIG is administered by a healthcare professional in a hospital outpatient clinic once every 3–4 weeks, and SCIG is administered at home once every 1–4 weeks. SCIG provides the patient with the convenience to selfinfuse at home, whereas IVIG does not. Facilitated SCIG treatment has two components: IgG 10% and recombinant human hyaluronidase (rHuPh20). Facilitated SCIG treatment has two components: IgG 10% and recombinant human hyaluronidase (rHuPh20). rHuPH20 is infused first resulting in a transient and local increase in subcutaneous tissue permeability, allowing larger doses of immunoglobulin (IG) to be administered every 3–4 weeks [9,10,11,12,13]
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