Cost Effectiveness of Prophylactic Intravenous Immune Globulin in Chronic Lymphocytic Leukemia

Abstract

Decision-analysis modeling may be applied to the results of randomized controlled trials to assess the potential clinical and financial effects of adopting the intervention in medical practice. In the case of intravenous immune globulin therapy in patients with chronic lymphocytic leukemia and hypogammaglobulinemia, this type of analysis suggests that treatment might not result in improved quality or length of life and that it is extraordinarily expensive in comparison with other treatments generally accepted as cost effective.

Evaluating the Cost-Effectiveness of Clinical and Public Health Measures

“…The reported C/E ratios per QALY vary enormously, from less than $1000 (69) to over $1,000,000 (15,72). Although it is tempting to make strict comparisons of the C/E ratios in Table 1, it is important to recognize the differences in how these studies were conducted and the nature of the information and assumptions that were employed.…”

“…The number of lives saved was the metric of health outcome used in most of the primary prevention CEAs (43,71). The analyses of secondary prevention measures were more likely to use LYs (14)(15)(16)18), while QALYs were used in most of the analyses of tertiary measures (28,60,72). Quality weights were more likely to be based on physician (rather than community) preferences (60, 72) and were not routinely derived from standard gamble or time-trade-off techniques.…”

“…Analysis of incremental costs was not performed uniformly. Discounting of future costs and health benefits was common but not universal (43,72). When discounting was performed, a 5% rate was used most commonly, but a rate of 3% was also employed on occasion.…”

“…Weeks et al studied the cost-effectiveness of prophylactically treating chronic lymphocytic leukemia patients with intravenous immunoglobulin (72). The authors developed a decision analysis model to compare their proposed treatment with no immunoglobulin therapy.…”

“…The secondary prevention studies included analyses of Pap smears for women aged 20 to 75 (15), Pap smears for women older than 65 (18), annual fecal occult blood tests (FOBT) to screen for colorectal cancer (16), annual mammography for women aged 55 to 65 (14,41), and annual mammography for women aged 40 to 50 (14). The treatment interventions included treatment strategies for breast cancer (28,60), metastatic non-small cell lung cancer (59), and chronic lymphocytic leukemia (72). A more detailed description of each study follows.…”