Switching Patients to Home-Based Subcutaneous Immunoglobulin: an Economic Evaluation of an Interprofessional Drug Therapy Management Program
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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.
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).
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.
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.
KeywordsImmunoglobulin intravenous subcutaneous management program interprofessional
All co-authors have reviewed the manuscript and have contributed in a substantive and intellectual manner to the work.
Compliance with Ethical Standards
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.
- 1.APIIEG. Consensus recommendations for the use of immunoglobulin replacement therapy in immune deficiency: Asia Pacific Immunoglobulins in Immunology Expert Group 2009.Google Scholar
- 3.Modell V, Gee B, Lewis DB, Orange JS, Roifman CM, Routes JM, et al. Global study of primary immunodeficiency diseases (PI)—diagnosis, treatment, and economic impact: an updated report from the Jeffrey Modell Foundation. Immunol Res. 2011;51(1):61–70. doi: 10.1007/s12026-011-8241-y.CrossRefPubMedGoogle Scholar
- 6.European Society for Immunodeficiencies (ESID). http://esid.org/. 2015.
- 10.Nicolay U, Kiessling P, Berger M, Gupta S, Yel L, Roifman CM, et al. Health-related quality of life and treatment satisfaction in North American patients with primary immunedeficiency diseases receiving subcutaneous IgG self-infusions at home. J Clin Immunol. 2006;26(1):65–72. doi: 10.1007/s10875-006-8905-x.CrossRefPubMedGoogle Scholar
- 19.Liu Z, Albon E, GHyde C, WMHTA C. The effectiveness and cost effectiveness of immunoglobulin replacement therapy for primary immunodeficiency and chronic lymphocytic leukaemia: a systematic review and economic evaluation. University of Birmingham: Department of Public Health and Epidemiology2005.Google Scholar
- 24.Bourdin A, Berger J, Bugnon O. Immunoglobulin self-infusion: an interprofessional drug therapy management program. 42nd European Symposium on Clinical Pharmacy symposium on Clinical Pharmacy: Implementation of Pharmacy Practice; 16-18 October 2013; Prague, Czech Republic: International Journal of Clinical Pharmacy; 2013. p. 1281-2.Google Scholar
- 26.Ducruet T, Levasseur MC, Des Roches A, Kafal A, Dicaire R, Haddad E. Pharmacoeconomic advantages of subcutaneous versus intravenous immunoglobulin treatment in a Canadian pediatric center. J Allergy Clin Immunol. 2013;131(2):585-7 e1-3. doi: 10.1016/j.jaci.2012.08.022.
- 27.Drummond MF. Sculpher MJ. Torrance GW: O’Brien B, Stoddart GL. Methods for the Economic Evaluation of Health Care Programmes. Oxford University Press; 2005.Google Scholar
- 31.Bourdin A, Berger J, Perraudin C, Bugnon O. Therapy management program for immunoglobulin self-infusion: patients’ reported outcomes. 43rd European Symposium on Clinical Pharmacy: Patient Safety - Bridging the Gaps; 22–24 October 2014; Copenaghen, Denmark: International Journal of Clinical Pharmacy; 2014. p. p 179-287.Google Scholar