Home versus hospital immunoglobulin treatment for autoimmune neuropathies: A cost minimization analysis

Abstract

BackgroundPrior clinical trials have suggested that home‐based Ig treatment in multifocal motor neuropathy (MMN) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and its variant Lewis–Sumner syndrome (LSS) is safe and effective and is less costly than hospital‐administered intravenous immunoglobulin (IVIg).MethodsA French prospective, dual‐center, cost minimization analysis was carried out to evaluate IVIg administration (5% concentrated) at home versus in hospital with regard to costs, patients’ autonomy, and patients’ quality of life. The primary endpoint was the overall cost of treatment, and we adopted the perspective of the payer (French Social Health Insurance).ResultsTwenty‐four patients aged 52.3 (12.2) years were analyzed: nine patients with MMN, eight with CIDP, and seven with LSS. IVIg (g/kg) dosage was 1.51 ± 0.43 in hospital and 1.52 ± 0.4 at home. Nine‐month total costs per patient extrapolated to 1 year of treatment were €48,189 ± 26,105 versus €91,798 ± 51,125 in the home and hospital groups, respectively (p < .0001). The most frequently reported factors for choosing home treatment were the good tolerance and absence of side effects of IVIg administration, as well as a good understanding of the advantages and drawbacks of home treatment (75% of respondents). The mRankin scores before and after switch to home treatment were 1.61 ± 0.72 and 1.36 ± 0.76, respectively (p = .027).DiscussionThe switch from hospital‐based to home‐based IVIg treatment for patients with immune neuropathy represents potentially significant savings in the management of the disease.

The economic burden of CIDP in the United States: A case-control study

“…Yet, our observation of high CIDP therapy costs, and high costs of IVIg specifically, highlights the importance of optimally managing the treatment of CIDP while considering both clinical benefit and costs. Setting of care has also been identified as an important cost driver for IVIg, with IVIg administration in the outpatient hospital setting associated with higher costs compared to IVIg administration in the home setting [ 17 , 18 ]. While we did not specifically evaluate IVIg costs, setting of care is not comprehensively recorded in the database for IVIg administration, limiting our ability to investigate this cost driver.…”

Home-based subcutaneous immunoglobulin for chronic inflammatory demyelinating polyneuropathy patients: A Swiss cost-minimization analysis

“…For many patients, the home setting is the preferable therapy option leading to more autonomy and flexibility in SCIg [38,39] or IVIg [40], as long as training and follow-up by professionals are provided [41]. Moreover, in a pandemic situation, the home setting avoids bringing chronic patients to the hospital for treatment.…”

“…Our study did not investigate the cost-effectiveness of home-based IVIg, which is uncommon in Switzerland but appears to be an acceptable efficient alternative in other countries such as in France for patients with autoimmune neuropathies [40]. We considered that this management strategy is more expensive than SCIg for the health insurers accounting avoided hospital costs but a higher IgG cost and long-term costs associated to recurrent home-based care.…”

Management of chronic inflammatory demyelinating polyradiculopathy

“…A recent meta-analysis concluded that the use of SCIg was associated with a 28% reduction in the risk of moderate and/or systemic adverse effects compared with IVIg, with a similar efficacy [46]. An alternative to SCIg could be home-based IVIg therapy [47], although this possibility is not yet allowed in all countries.…”