Abstract
SUMMARYObjectiveThe objective of this study is to evaluate the economic benefits of immunoglobulin replacement therapy achieved subcutaneously (subcutaneous immunoglobulin, SCIG) by the rapid push method compared to intravenous infusion therapy (intravenous immunoglobulin, IVIG) in primary immune deficiency (PID) patients from the healthcare system perspective in the context of the adult SCIG home infusion program based at St Paul's Hospital, Vancouver, Canada.Materials and methodsSCIG and IVIG options were compared in cost-minimisation and budget impact models (BIMs) over 3 years. Sensitivity analyses were performed for both models to evaluate the impact of varying modality of IVIG treatments and proportion of patients switching from IVIG to SCIG.ResultsThe cost-minimisation model estimated that SCIG treatment reduced cost to the healthcare system per patient of $5736 over 3 years, principally because of less use of hospital personnel. This figure varied between $5035 and $8739 depending on modality of IVIG therapy. Assuming 50% of patients receiving IVIG switched to SCIG, the BIM estimated cost savings for the first 3 years at $1·308 million or 37% of the personnel and supply budget. These figures varied between $1·148 million and $2·454 million (36 and 42%) with varying modalities of IVIG therapy. If 75% of patients switched to SCIG, the reduced costs reached $1·962 million or 56% of total budget.ConclusionThis study demonstrated that from the health system perspective, rapid push home-based SCIG was less costly than hospital-based IVIG for immunoglobulin replacement therapy in adult PID patients in the Canadian context.
Highlights
Primary immune deficiencies (PIDs) are a group of chronic disorders that can affect patients at various ages (Shehata et al, 2010)
Using subcutaneous immunoglobulin (SCIG) was less costly than Intravenous immunoglobulin (IVIG) treatment to the healthcare system by $5736 per patient for the first 3 years of therapy
The main cost difference between the two options was personnel cost, which was greater for IVIG than SCIG: $2378 for IVIG versus $630 for the first year and $315 for the second and third years of SCIG treatment
Summary
Primary immune deficiencies (PIDs) are a group of chronic disorders that can affect patients at various ages (Shehata et al, 2010). Similar efficacy in preventing infections has been reported between SCIG and IVIG with no difference in severity and length of infections (Chapel et al, 2000; Shehata et al, 2010) These two treatment options are associated with similar efficacy and safety profiles, (Chapel et al, 2000) switching from hospital-based IVIG to home-based SCIG was shown to significantly improve healthrelated quality of life (HRQoL) of adult PID patients (Gardulf et al, 2004; Kittner et al, 2006; Nicolay et al, 2006)
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