PATH Research Institute, McMaster University, Hamilton, Ontario, Canada.
Cost Eff Resour Alloc. 2010 Jun 17;8:14. doi: 10.1186/1478-7547-8-14.
Intravenous immunoglobulin (IVIG) has demonstrated improvement in chronic inflammatory demyelinating polyneuropathy (CIDP) patients in placebo controlled trials. However, IVIG is also much more expensive than alternative treatments such as corticosteroids. The objective of the paper is to evaluate, from a Canadian perspective, the cost-effectiveness of IVIG compared to corticosteroid treatment of CIDP.
A markov model was used to evaluate the costs and QALYs for IVIG and corticosteroids over 5 years of treatment for CIDP. Patients initially responding to IVIG could remain a responder or relapse every 12 week model cycle. Non-responding IVIG patients were assumed to be switched to corticosteroids. Patients on corticosteroids were at risk of a number of adverse events (fracture, diabetes, glaucoma, cataract, serious infection) in each cycle.
Over the 5 year time horizon, the model estimated the incremental costs and QALYs of IVIG treatment compared to corticosteroid treatment to be $124,065 and 0.177 respectively. The incremental cost per QALY gained of IVIG was estimated to be $687,287. The cost per QALY of IVIG was sensitive to the assumptions regarding frequency and dosing of maintenance IVIG.
Based on common willingness to pay thresholds, IVIG would not be perceived as a cost effective treatment for CIDP.
静脉注射免疫球蛋白（IVIG）已在安慰剂对照试验中证明可改善慢性炎症性脱髓鞘性多发性神经病（CIDP）患者的病情。然而，IVIG 比皮质类固醇等替代疗法昂贵得多。本文的目的是从加拿大的角度评估 IVIG 与皮质类固醇治疗 CIDP 的成本效益。
使用马尔可夫模型评估 IVIG 和皮质类固醇治疗 CIDP 5 年的成本和 QALY。最初对 IVIG 有反应的患者可以保持反应者或每 12 周模型周期复发。假设对 IVIG 无反应的患者将改用皮质类固醇。皮质类固醇患者在每个周期都有发生多种不良事件（骨折、糖尿病、青光眼、白内障、严重感染）的风险。
在 5 年的时间内，该模型估计与皮质类固醇治疗相比，IVIG 治疗的增量成本和 QALY 分别为 124,065 美元和 0.177。IVIG 每获得一个 QALY 的增量成本估计为 687,287 美元。IVIG 的每 QALY 成本对维持性 IVIG 的频率和剂量假设敏感。
根据常见的支付意愿阈值，IVIG 不会被认为是 CIDP 的一种具有成本效益的治疗方法。
