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Open Access Highly Accessed Research article

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

Jeffrey L Winters1*, David Brown2, Elisabeth Hazard3, Ashok Chainani3 and Chester Andrzejewski4

Author Affiliations

1 Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First ST SW, Rochester, MN 55905, USA

2 Pharmacy Department, Health New England, One Monarch Place STE 1500, Springfield, MA 01144, USA

3 Pricing & Reimbursement Strategy, ACE Strategic Reimbursement, 909 Jessica Terrace, Downingtown, PA 19335, USA

4 Pathology Department, Baystate Medical Center, 759 Chestnut ST, Springfield, MA 01199, USA

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BMC Health Services Research 2011, 11:101  doi:10.1186/1472-6963-11-101

Published: 16 May 2011

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords:
plasma exchange; intravenous immunoglobulin; Guillain-Barré syndrome; cost effectiveness