Cost-utility analysis comparing hospital-based intravenous immunoglobulin with home-based subcutaneous immunoglobulin in patients with secondary immunodeficiency
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Author(s)
Windegger, Tanja M
Nghiem, Son
Kim-Huong, Nguyen
Fung, Yoke-Lin
Scuffham, Paul A
Griffith University Author(s)
Year published
2019
Metadata
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Background and Objective
Immunoglobulin replacement therapy (IRT) is often used to support patients with primary immunodeficiency disease (PID) and secondary immunodeficiency disease (SID). Home‐based subcutaneous immunoglobulin (SCIg) is reported to be a cheaper and more efficient option compared to hospital‐based intravenous immunoglobulin (IVIg) for PID. In contrast, there is little information on the cost‐effectiveness of IRT in SID. However, patients who develop hypogammaglobulinaemia secondary to other conditions (SID) have different clinical aetiology compared to PID. This study assesses whether SCIg provides a good ...
View more >Background and Objective Immunoglobulin replacement therapy (IRT) is often used to support patients with primary immunodeficiency disease (PID) and secondary immunodeficiency disease (SID). Home‐based subcutaneous immunoglobulin (SCIg) is reported to be a cheaper and more efficient option compared to hospital‐based intravenous immunoglobulin (IVIg) for PID. In contrast, there is little information on the cost‐effectiveness of IRT in SID. However, patients who develop hypogammaglobulinaemia secondary to other conditions (SID) have different clinical aetiology compared to PID. This study assesses whether SCIg provides a good value‐for‐money treatment option in patients with secondary immunodeficiency disease (SID). Methods A Markov cohort simulation model with six health states was used to compare cost‐effectiveness of IVIg with SCIg from a healthcare system perspective. The costs of treatment, infection and quality‐adjusted life years (QALYs) for IVIg and SCIg treatment options were modelled with a time horizon of 10 years and weekly cycles. Deterministic and probabilistic sensitivity analyses were performed around key parameters. Results The cumulative cost for IVIg was A$151 511 and for SCIg A$144 296. The QALYs with IVIg were 3·07 and with SCIg 3·51. Based on the means, SCIg is the dominant strategy with better outcomes and at lower cost. The probabilistic sensitivity analysis shows that 88·3% of the 50 000 iterations fall below the nominated willingness to pay threshold of A$50 000 per QALY. Therefore, SCIg is a cost‐effective treatment option. Conclusion For SID patients in Queensland (Australia), the home‐based SCIg treatment option provides better health outcomes and cost savings.
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View more >Background and Objective Immunoglobulin replacement therapy (IRT) is often used to support patients with primary immunodeficiency disease (PID) and secondary immunodeficiency disease (SID). Home‐based subcutaneous immunoglobulin (SCIg) is reported to be a cheaper and more efficient option compared to hospital‐based intravenous immunoglobulin (IVIg) for PID. In contrast, there is little information on the cost‐effectiveness of IRT in SID. However, patients who develop hypogammaglobulinaemia secondary to other conditions (SID) have different clinical aetiology compared to PID. This study assesses whether SCIg provides a good value‐for‐money treatment option in patients with secondary immunodeficiency disease (SID). Methods A Markov cohort simulation model with six health states was used to compare cost‐effectiveness of IVIg with SCIg from a healthcare system perspective. The costs of treatment, infection and quality‐adjusted life years (QALYs) for IVIg and SCIg treatment options were modelled with a time horizon of 10 years and weekly cycles. Deterministic and probabilistic sensitivity analyses were performed around key parameters. Results The cumulative cost for IVIg was A$151 511 and for SCIg A$144 296. The QALYs with IVIg were 3·07 and with SCIg 3·51. Based on the means, SCIg is the dominant strategy with better outcomes and at lower cost. The probabilistic sensitivity analysis shows that 88·3% of the 50 000 iterations fall below the nominated willingness to pay threshold of A$50 000 per QALY. Therefore, SCIg is a cost‐effective treatment option. Conclusion For SID patients in Queensland (Australia), the home‐based SCIg treatment option provides better health outcomes and cost savings.
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Journal Title
VOX SANGUINIS
Volume
114
Issue
3
Copyright Statement
© 2019 International Society of Blood Transfusion. This is the peer reviewed version of the following article: Cost–utility analysis comparing hospital‐based intravenous immunoglobulin with home‐based subcutaneous immunoglobulin in patients with secondary immunodeficiency, Vox Sanguinis, Vol. 114, 237–246, 2019, which has been published in final form at 10.1111/vox.12760. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-828039.html)
Subject
Clinical sciences
Medical physiology