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



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.

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