Cost–utility analysis of intravenous immunoglobulin and prednisolone for chronic inflammatory demyelinating polyradiculoneuropathy

McCrone, Paul; Chisholm, Daniel; Knapp, Martín; Hughes, Richard; Comi, Giancarlo; Dalakas, Marinos C.; Illa, Isabel; Kilindireas, Costas; Nobile‐Orazio, Eduardo; Swan, A V; Bergh, Peter Van den; Willison, Hugh J.

doi:10.1046/j.1351-5101.2003.00701.x

Cited by 71 publications

(46 citation statements)

References 25 publications

(48 reference statements)

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“…How the absence of disruption in working and daily activities, as well as the time saved from moving back and forth between home and hospital for immunoglobulin administration, improves SCIG patients' health-related quality of life (HRQoL) is still debated [9,34] and shall benefit from further investigations on samples of patients of adequate size.…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous vs intravenous administration of immunoglobulin in chronic inflammatory demyelinating polyneuropathy: an Italian cost-minimization analysis

Lazzaro¹,

Lopiano

Cocito

2014

Neurol Sci

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Prior researches have suggested that home-based subcutaneous immunoglobulin (SCIG) is equally effective and can be less expensive than hospital-based intravenous immunoglobulin (IVIG) in treating chronic inflammatory demyelinating polyneuropathy (CIDP) patients. This economic evaluation aims at comparing costs of SCIG vs IVIG for CIDP patients in Italy. A 1-year model-based cost-minimization analysis basically populated via neurologists' opinion was undertaken from a societal perspective. Health care resources included immunoglobulin; drugs for premedication and complications (rash, headache, and hypertension) management; time of various health care professionals; pump for SCIG self-administration; infusion disposables. Non-health care resources encompassed transport and parking; losses of working and leisure time for patients and caregivers. Unit or yearly costs for resources valuation were mainly obtained from published sources. Costs were expressed in Euro (€) 2013. An extensive one-way sensitivity analysis (OWSA) and a scenario SA tested the robustness of the base case findings. Overall costs per patient amount to €49,534.75 (SCIG) and €50,895.73 (IVIG); saving in favour of SCIG reaches €1360.98. For both SCIG and IVIG, the cost driver was immunoglobulin (94.06 vs 86.06 % of the overall costs, respectively). Sensitivity analyses confirmed the consistency of the baseline results. SCIG may be a cost-saving therapy for Italian CIDP patients.

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Section: Discussionmentioning

confidence: 99%

Subcutaneous vs intravenous administration of immunoglobulin in chronic inflammatory demyelinating polyneuropathy: an Italian cost-minimization analysis

Lazzaro¹,

Lopiano

Cocito

2014

Neurol Sci

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“…Although, IVIG is considered safe for long-term administration, compared with other effective therapeutic modalities such as PE, corticosteroids, or immunosuppressants used in autoimmune neuromuscular disorders, there are no comparative long-term data. The same also applies to pharmacoeconomics, where no long-term comparative studies between these therapies have been performed, except for some limited data being obtained for CIDP [115].…”

Section: Differences In Products and Pharmacoeconomicsmentioning

confidence: 99%

Efficacy of Intravenous Immunoglobulin in Neurological Diseases

2016

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Owing to its anti-inflammatory efficacy in various autoimmune disease conditions, intravenous immunoglobulin (IVIG)-pooled IgG obtained from the plasma of several thousands individuals-has been used for nearly three decades and is proving to be efficient in a growing number of neurological diseases. IVIG therapy has been firmly established for the treatment of Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and multifocal motor neuropathy, either as first-line therapy or adjunctive treatment. IVIG is also recommended as rescue therapy in patients with worsening myasthenia gravis and is beneficial as a second-line therapy for dermatomyositis and stiff-person syndrome. Subcutaneous rather than intravenous administration of IgG is gaining momentum because of its effectiveness in patients with primary immunodeficiency and the ease with which it can be administered independently from hospital-based infusions. The demand for IVIG therapy is growing, resulting in rising costs and supply shortages. Strategies to replace IVIG with recombinant products have been developed based on proposed mechanisms that confer the anti-inflammatory activity of IVIG, but their efficacy has not been tested in clinical trials. This review covers new developments in the immunobiology and clinical applications of IVIG in neurological diseases.

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“…Combination therapy has not been proven to be of increased efficacy[ 39]. Although there is concern that the cost-benefit ratio relative to steroids may be high with IVIG for CIDP, this ratio is likely to be lower once long-term side effects of corticosteroids are considered[ 47]. This is of particular importance in CIDP since it tends to be a more chronic, progressive or relapsing disease that may require prolonged treatment regimens[ 39].…”

Section: Indications With Substantial Evidence For Use As a First-linmentioning

confidence: 99%

Intravenous Immunoglobulin: Striving for Appropriate Use

Kumar¹,

Teuber²,

Gershwin³

2006

Int Arch Allergy Immunol

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Background: Intravenous immunoglobulin (IVIG) is the mainstay therapy in human immune deficiency states characterized by qualitative and quantitative reductions in B cells. In addition, however, there is widespread use of IVIG in a number of other areas, including neuroimmunologic, infectious, dermatologic, hematologic, autoimmune, inflammatory and idiopathic disorders. In many of these cases, there are little objective data to support the use. Methods: We performed a review of more than 400 publications in PubMed using the key words ‘intravenous immunoglobulin’ and excluded publications that focused on immune deficiency, for which the indication for IVIG is already clear. Results: For a number of off-label indications, there is significant evidence of efficacy and IVIG has become the standard of care for many clinical syndromes other than immune deficiency. In some conditions, however, the data have not been well controlled or randomized and are often limited to case reports that are difficult to interpret. Although the critical shortage of IVIG of the last decade is no longer an issue, IVIG is expensive and not without risk. The use of IVIG should be based not only on clinical data, but also, and especially, on the biological rationale for its use. Conclusions: The appropriate use of IVIG is an important issue that is difficult to resolve, and will continue to challenge clinicians based on expense and potentially limited supply, including the intrinsic limitations of donor plasma. The establishment of national and international voluntary registries to report use of IVIG in disorders for which evidence is lacking would be a first step toward facilitating randomized, controlled clinical trials.

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Cost–utility analysis of intravenous immunoglobulin and prednisolone for chronic inflammatory demyelinating polyradiculoneuropathy

Cited by 71 publications

References 25 publications

Subcutaneous vs intravenous administration of immunoglobulin in chronic inflammatory demyelinating polyneuropathy: an Italian cost-minimization analysis

Subcutaneous vs intravenous administration of immunoglobulin in chronic inflammatory demyelinating polyneuropathy: an Italian cost-minimization analysis

Efficacy of Intravenous Immunoglobulin in Neurological Diseases

Intravenous Immunoglobulin: Striving for Appropriate Use

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