Arj-ong Sakda, Chotivitayatarakorn Pairoj, Lertsapcharoen Pornthep, Khongphatthanayothin Apichai, Thisyakorn Chule
Division of Cardiology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
J Med Assoc Thai. 2003 Jun;86 Suppl 2:S179-88.
To determine the long-term cost-benefit of intravenous immunoglobulin (IVIG) treatment in Children with Kawasaki Disease (KD), a model was made to compare the total cost for management of these children with and without the use of IVIG. Long-term (10-21 years) follow-up of 594 KD patients treated in the pre-IVIG era reported by Kato, et al. was used to calculate cost using previous cost studies from Chulalongkorn Hospital. Reduction of CAA from 25 per cent to 4 per cent with IVIG treatment was assumed based on previous published data. Total cost was slightly lower for the non-IVIG treatment group compared to the IVIG treatment group (33,451,129 baht vs 35,001,195 baht) for the duration of follow-up in Kato's model. Cost per effectiveness analysis showed more effectiveness in the IVIG treatment group (359,576 baht vs 383,614 baht). Net cost analysis similarly demonstrated lower costs in the IVIG treatment group (25,365,215 baht vs 33,451,129 baht). Incremental cost-effectiveness analysis demonstrated supplementary costs of 13,663 baht for one case in the reduction of coronary involvement and 387,517 baht for one life saved in the IVIG-treated group. Estimation of total costs for follow-up and treatment for healthy life (until 60 years old) was more expensive in the non-IVIG treatment than the IVIG treated group (75,482,803 baht vs 29,883,833 baht). The authors conclude that treatment of all KD cases in Thailand with IVIG is likely to result in lower cost and better outcome when compared to no treatment with the IVIG policy.
为了确定静脉注射免疫球蛋白（IVIG）治疗川崎病（KD）患儿的长期成本效益，构建了一个模型，比较使用IVIG和不使用IVIG治疗这些患儿的总成本。利用Kato等人报告的在IVIG时代之前接受治疗的594例KD患者的长期（10 - 21年）随访数据，结合朱拉隆功医院先前的成本研究来计算成本。根据先前发表的数据，假设IVIG治疗可使冠状动脉瘤（CAA）从25%降至4%。在Kato的模型中，随访期间非IVIG治疗组的总成本略低于IVIG治疗组（33,451,129泰铢对35,001,195泰铢）。成本效益分析显示IVIG治疗组更具效益（359,576泰铢对383,614泰铢）。净成本分析同样表明IVIG治疗组成本更低（25,365,215泰铢对33,451,129泰铢）。增量成本效益分析表明，在IVIG治疗组中，减少一例冠状动脉受累的补充成本为13,663泰铢，挽救一条生命的补充成本为387,517泰铢。对健康生活（直至60岁）的随访和治疗总成本估计显示，非IVIG治疗组比IVIG治疗组更昂贵（75,482,803泰铢对29,883,833泰铢）。作者得出结论，与不采用IVIG治疗策略相比，泰国所有KD病例采用IVIG治疗可能会降低成本并带来更好的结果。
