Cost-minimization analysis of immunoglobulin treatment of primary immunodeficiency diseases in Spain

Abstract

Primary immunodeficiency diseases (PID), which are comprised of over 400 genetic disorders, occur when a component of the immune system is diminished or dysfunctional. Patients with PID who require immunoglobulin (IG) replacement therapy receive intravenous IG (IVIG) or subcutaneous IG (SCIG), each of which provides equivalent efficacy. We developed a cost-minimization model to evaluate costs of IVIG versus SCIG from the Spanish National Healthcare System perspective. The base case modeled the annual cost per patient of IVIG and SCIG for the mean doses (per current expert clinical practice) over 1 year in terms of direct (drug and administration) and indirect (lost productivity for adults and parents/guardians of pediatric patients) costs. It was assumed that all IVIG infusions were administered in a day hospital, and 95% of SCIG infusions were administered at home. Drug costs were calculated from ex-factory prices obtained from local databases minus the mandatory deduction. Costs were valued on 2018 euros. The annual modeled costs were €4,266 lower for patients with PID who received SCIG (total €14,466) compared with those who received IVIG (total €18,732). The two largest contributors were differences in annual IG costs as a function of dosage (– €1,927) and hospital administration costs (– €2,688). However, SCIG incurred training costs for home administration (€695). Sensitivity analyses for two dose-rounding scenarios were consistent with the base case. Our model suggests that SCIG may be a cost-saving alternative to IVIG for patients with PID in Spain.

Ten-year population trends of immunoglobulin use, burden of adult antibody deficiency and feasibility of subcutaneous immunoglobulin (SCIg) replacement in Hong Kong Chinese

“…Furthermore, we also demonstrated that SCIg is more costeffective than IVIg as a form of immunoglobulin replacement for adult patients in Hong Kong. Our finding is similar to that of other cost-effective analysis studies in Australia, Canada, Iran, Spain, France, Japan and Switzerland (52)(53)(54)(55)(56)(57)(58). Projecting from the costs saved from immunodeficiency-related hospitalisation costs alone, we could potentially save HKD25,286 (USD3,221) per patient per year on SCIg compared to IVIg.…”

Increased Access to Immunoglobulin Replacement Therapy for Patients with Primary Immunodeficiency in Poland Based on Clinical Usage Data of Immunoglobulin G over a 5-Year Period

“…An example is a cost minimization model to evaluate costs of IVIG versus SCIG from the Spanish National Healthcare System perspective, with the assumption that all IVIG infusions were administered in a hospital and 95% of SCIG infusions were administered at home. This model is similar to our system and suggests that SCIG may be a cost-saving alternative to IVIG in patients with PID [ 21 ].…”

A retrospective review of immunology patients with primary and/or secondary immunodeficiency, demonstrating the benefits of the rapid transitioning from intravenous immunoglobulin to subcutaneous immunoglobulin at the onset of the COVID‐19 pandemic

“…The moderate savings, however, did not account for chair occupancy or nursing wages associated with IVIg hospital‐based therapy. International data from Canada, 17 the United Kingdom 18 and Spain 19 based on cost‐minimisation analysis also demonstrate considerable savings from human resources. Our study in contrast to the international data provides savings data from analysis of a cohort followed for 1 year rather than an estimate of savings based on an existing cohort.…”