Reducing the economic burden in management of Guillain–Barre syndrome using modified plasmapheresis

Abstract

Background:Guillain–Barre syndrome (GBS) is an autoimmune acute inflammatory demyelinating polyneuropathy affecting the peripheral nervous system treated with high-dose immunoglobulin, physical therapy, or plasmapheresis. Immunoglobulins are expensive and even plasmapheresis might not be affordable to patients visiting government set-ups.Aims:This study was undertaken to emphasize the efficacy of plasmapheresis in treatment of adult GBS patients and to narrate methods of reducing the economic burden in the treatment of these patients using modified plasmapheresis.Methods:A study was conducted on 12 adult GBS patients at Sir Takhtasinhji General Hospital, Bhavnagar from July 2012 to July 2014. Patients were assessed on a 6-point disability scale. They were treated with plasmapheresis over 10 days with REF627 kit from Haemonetics Corporation Limited on MCS+ machine. Improvement was noted by the change in the disability scale score and expenses of various modes of treatment were also considered.Results:Seventy-five percent showed improvement at the end of the treatment. The cost of modified plasmapheresis was Rs. 8000/cycle, i.e., Rs. 40,000/patient.Conclusion:Plasmapheresis along with proper supportive measures is a more cost-effective efficacious mode of therapy in adult patients of GBS. Further, modified plasmapheresis using REF627 kit and 6% hexastarch as replacement fluid on MCS+ apheresis machine reduces the cost of therapy for poor patients visiting government set-ups.

Guillain–Barré syndrome in low-income and middle-income countries: challenges and prospects

“…This situation underscores the need for low-cost and effective treatment strategies for GBS in LMIC. Small volume plasma exchange (SVPE) is a novel, relatively low cost (~$500), simple technique for selective removal of plasma, and has been shown to be a safe and feasible treatment for GBS in resource-limited settings such as India and Bangladesh 18 , 110 . However, as the efficacy of SVPE has only been shown in a small number of patients, large-scale studies are required before this technique can be implemented in routine clinical practice.…”

Nationwide study of therapeutic plasma exchange vs intravenous immunoglobulin in Guillain‐Barré syndrome

“…Recently published comparative and noncomparative studies of GBS outcomes after treatment with TPE and/or IVIG have consisted primarily of case reports or case series from single institutions in developing countries, at which the choice between TPE and IVIG is largely dependent on economic considerations . Given the established equivalence between TPE and IVIG as effective treatments for GBS, it is important to evaluate patient‐ and hospital‐level characteristics that may affect treatment selection.…”

Guillain-Barré Syndrome (GBS)- A Review

“…In serious GBS, 6 meetings are no superior to 4. In accordance with these discoveries, Yuki et al revealed that in any event 2 PE are expected to fundamentally decrease the coursing immunoglobulin complexes 27 . Besides IVIg and plasma trade, no different strategies or medications have been demonstrated successful in the treatment of GBS.…”