Cost-minimization analysis of the direct costs of TPE and IVIg in the treatment of Guillain-Barré syndrome
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
BMC Health Services Research 2011, 11:101 doi:10.1186/1472-6963-11-101Published: 16 May 2011
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.
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.
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.
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.