Economic benefits of subcutaneous rapid push versus intravenous immunoglobulin infusion therapy in adult patients with primary immune deficiency

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.

Rapid push: new opportunities in subcutaneous immunoglobulin replacement therapy

“…SCIG treatment leads to less infectious complications on the one hand, and to lower costs of treatment on the other [5,17]. That route seems to be cheaper for both the health care providers (reduction in hospital/clinic costs) and patients/ parents (no need to visit hospital every 3-4 weeks) [20].…”

“…Immunoglobulin can never be infused into an area that is tender, bruised, red or hard. Some patients prefer administration at two sites and less frequent infusions [17]. Some studies compared the rapid push versus infusion pump in patients with PAD [21].…”

“…It is overwhelmingly favored by children and adults over IVIG. Several reports on the safety and efficacy of SCIG therapy in both children and adults [5][6][7][8][9] show that subcutaneous gammaglobulin preparations are well tolerated, giving sporadically adverse events, and can be given at home [3,4,[7][8][9][10][17][18][19]. It has also been shown that regular subcutaneous infusions allow for keeping the IgG level more stable.…”

“…It has also been shown that regular subcutaneous infusions allow for keeping the IgG level more stable. Pharmacokinetically, SCIG has a flatter serum concentration profile compared with IVIG, minimizing the potential risk of systemic adverse events (AEs) from initially high peak values or 'wearing-off' effects from low trough values at the end of a 3-to 4-week dosing interval [5,10,17,20]. In a randomized, cross-over study by Chapel, the number and severity of infections were the same during IVIG and SCIG therapy [3].…”

“…In Poland, SCIG therapy was introduced in 2001 at the Children's Memorial Health Institute in Warsaw. Comparison of two methods in children revealed a slightly lower number of infections and days with antibiotics due to infections on subcutaneous infusions, indicating SCIG as a better choice of treatment in some group of patients [4,[13][14][15][16][17].…”