Treatment of Guillain-Barr� syndrome: A cost-effectiveness analysis

Abstract

Acute Guillain‐Barré syndrome is the most common cause of neuromuscular paralysis. Plasma exchange and intravenous immune globulin (IV IgG) are both effective treatments for this condition and the purpose of this report was to compare the cost‐effectiveness of these two modalities. A MEDLINE search was performed to identify randomized studies that compared the use of IV IgG and plasma exchange for treatment of acute Guillain‐Barré syndrome to determine if one modality was more effective and/or safer for the management of this condition. A decision analysis was structured around the alternatives facing neurologists who must choose a treatment regimen for patients diagnosed with acute Guillain‐Barré syndrome who require active therapy. Cost information was obtained directly from product manufacturers and hospital sources. Two head‐to‐head trials comparing the effectiveness of plasma exchange and IV IgG for treatment of acute Guillain‐Barré syndrome determined that there was insufficient evidence to suggest one therapy was more effective than the other; therefore, a cost minimization analysis was performed. The costs per patient of plasma exchange and IV IgG for the treatment of acute Guillain‐Barré syndrome were $6,204 and $10,165, respectively. A sensitivity analysis determined the model was sensitive to the cost of IV IgG. The cost savings per patient treatment for the use of plasma exchange varied from $304 to $6,625 depending on the IV IgG product selected. Plasma exchange and IV IgG are both effective treatments for Guillain‐Barré syndrome. However, our analysis determined plasma exchange on average was almost $4,000 less costly per patient than IV IgG. Further research is required to determine the impact of patient and physician preferences on the treatment of this disorder. J. Clin. Apheresis 14:107–113, 1999. © 1999 Wiley‐Liss, Inc.

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

“…However, decision makers may want to compare interventions in one area of medicine with those in another and this has led to a particular form of costeffectiveness analysis called cost-utility analysis which measures outcomes in generic units, typically quality-adjusted life years (QALYs). Economic evaluations are rare in the area of peripheral nerve disorders, but there have been studies of the use of plasma exchange for Guillain-Barré Syndrome [9,10] and one comparing IVIg and plasma exchange for the same condition [11]. However, no previous cost-effectiveness analyses of treatments for CIDP appear to have been conducted.…”

Retrospective Analysis of Cases with Guillain-Barré Syndrome in Pediatric Intensive Care Unit

“…İskoçya ve Amerika Birleşik Devletleri'nde yapılan ve 5 seans PD ile 5 günlük İVİG tedavisinin karşılaştırıldığı maliyet verimliliği çalışmalarında PD tedavisinin İVİG tedavisine göre yarı yarıya daha az maliyetli olduğu ve benzer etkinlikleri nedeniyle öncelikle tercih edilebileceği bildirilmektedir. 23,24 Bununla birlikte bu çalışmalar erişkin yaş grubunda yapılmıştır. Çocuk yaş grubunda plazma değişim işlemi teknik olarak (plazma değişim setleri) erişkinlere benzer maliyette olup albümin ve İVİG maliyeti ise hasta yaşı küçüldükçe azalacaktır.…”

Inflammatory Demyelinating Neuropathies

“…Cost/cost-effectiveness In GBS, one study [33] calculated the cost of treating an average patient with HIG (0.4 g/kg×5 doses) to be $10,165 per patient. The cost of treating an average patient with PE using five exchanges with 3.5 l of replacement fluid per exchange was $6,204 per patient.…”