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Switching Patients to Home-Based Subcutaneous Immunoglobulin: an Economic Evaluation of an Interprofessional Drug Therapy Management Program

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Abstract

Purpose

Home-based subcutaneous immunoglobulin (SCIg) therapy is an alternative to hospital-based intravenous infusions (IVIg). However, SCIg requires patient training and long-term support to ensure proper adherence, optimal efficacy and safety. We evaluated if switching patients to home-based SCIg including an interprofessional drug therapy management program (physician, community pharmacist and nurse) would be cost-effective within the Swiss healthcare system.

Methods

A 3-year cost-minimization analysis was performed from a societal perspective comparing monthly IVIg in an outpatient clinic and home-based weekly SCIg including an interprofessional program. Healthcare costs (immunoglobulin, professional time, infusion pump and disposables) were derived from administrative data. Transportation and productivity loss were estimated by expert opinion. The results were expressed in Swiss francs (CHF) and converted to Euros and US dollars (1 CHF = 0.92€, 1 CHF = $1.02; www.xe.com, 12/14/2015).

Results

Under base case assumptions, SCIg was estimated to cost 35,862 CHF (33,134€; $36,595) per patient during the first year and 30,309 CHF (28,004€; $30,929) in subsequent years versus 35,370 CHF (32,679€; $36,095) per year for IVIg. The total savings from switching to SCIg with the interprofessional program were 9630 CHF (8897€; $9828) per patient over 3 years. The results were relatively sensitive to the cost per gram of IgG, the cost of equipment and the annual number of infusions.

Conclusion

Home-based SCIg including an interprofessional therapy management program may be an efficient alternative for patients. The program provides long-term support from self-administration training to the responsible use of therapy (proper adherence, optimal efficacy and safety). Over the short term, additional costs from purchasing equipment and the drug therapy management program were offset by avoiding hospital costs.

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Author Contributions

All co-authors have reviewed the manuscript and have contributed in a substantive and intellectual manner to the work.

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Authors and Affiliations

  1. Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Rue du Bugnon, 44, 1011, Lausanne, Switzerland

    Clemence Perraudin, Aline Bourdin, Jérôme Berger & Olivier Bugnon

  2. Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Rue du Bugnon, 44, 1011, Lausanne, Switzerland

    Clemence Perraudin, Aline Bourdin, Jérôme Berger & Olivier Bugnon

  3. Division of Immunology and Allergy, Lausanne University Hospital, Rue du Bugnon, 44, 1011, Lausanne, Switzerland

    Francois Spertini

Authors
  1. Clemence Perraudin
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  2. Aline Bourdin
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  3. Francois Spertini
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  4. Jérôme Berger
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  5. Olivier Bugnon
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Corresponding author

Correspondence to Clemence Perraudin.

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Conflict of Interest

Authors declare having no conflict of interest related to this work. Travel support and unrestricted grant was paid by CSL Behring for facilitating the academic project.

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Jérôme Berger and Olivier Bugnon are co-senior authors

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Perraudin, C., Bourdin, A., Spertini, F. et al. Switching Patients to Home-Based Subcutaneous Immunoglobulin: an Economic Evaluation of an Interprofessional Drug Therapy Management Program. J Clin Immunol 36, 502–510 (2016). https://doi.org/10.1007/s10875-016-0288-z

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  • DOI: https://doi.org/10.1007/s10875-016-0288-z

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