Cost-minimization analysis of the direct costs of TPE and IVIg in the treatment of Guillain-Barré syndrome

• Main Authors: Chainani Ashok, Hazard Elisabeth, Brown David, Winters Jeffrey L, Andrzejewski Chester
• Format: Article
• Language: English
• Published: BMC 2011-05-01
• Series: BMC Health Services Research
• Subjects: plasma exchange; intravenous immunoglobulin; Guillain-Barré syndrome; cost effectiveness
• Online Access: http://www.biomedcentral.com/1472-6963/11/101

<p>Abstract</p> <p>Background</p> <p>Controlled trials have found therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIg) infusion therapy to be equally efficacious in treating Guillain-Barré syndrome (GBS). Due to increases in the price of IVIg compared to human serum albumin (HSA), used as a replacement fluid in TPE, we examined direct hospital-level expenditures for TPE and IVIg for meaningful cost-differences between these treatments.</p> <p>Methods</p> <p>Using financial data from our two institutions, hospital cost profiles for IVIg and 5% albumin were established. Reimbursement amounts were obtained from publicly available Medicare data resources to determine payment rates for TPE, non-tunneled central catheter line placement, and drug infusion therapy. A model was developed which allows hospitals to input cost and reimbursement amounts for both IVIg and TPE with HSA that results in real-time valuations of these interventions.</p> <p>Results</p> <p>The direct cost of five IVIg infusion sessions totaling 2.0 grams per kilogram (g/kg) body weight was $10,329.85 compared to a series of five TPE procedures, which had direct costs of $4,638.16.</p> <p>Conclusions</p> <p>In GBS patients, direct costs of IVIg therapy are more than twice that of TPE. Given equivalent efficacy and similar severity and frequencies of adverse events, TPE appears to be a less expensive first-line therapy option for treatment of patients with GBS.</p>