Department of Pediatrics and
Department of Pediatrics and.
Hosp Pediatr. 2021 Jan;11(1):88-93. doi: 10.1542/hpeds.2020-0188. Epub 2020 Dec 8.
In 10% to 20% of cases, Kawasaki disease is refractory to intravenous immunoglobulin (IVIg), an expensive medication under a national shortage. Data suggest that infliximab is a viable alternative to a second dose of IVIg, with similar efficacy and safety. We compared the cost of a second IVIg dose to that of infliximab in the treatment of refractory Kawasaki disease (rKD).
A decision analysis model was used to compare rKD treatments: a second dose of IVIg at 2 g/kg versus infliximab at 10 mg/kg. Infliximab monitoring times were 24, 36, and 48 hours. Direct hospital costs beginning at rKD diagnosis were estimated by using 2016-2017 Truven MarketScan data. Redbook was used for drug costs. Calculations were applied to 3 hypothetical cohorts of 100 patients aged 2 (12.5 kg), 4 (16 kg), and 8 years (25.5 kg). Indirect costs included parental missed workdays.
The total direct cost for children receiving IVIg was $1 677 801, $1 791 652, and $2 100 675 for the 2-, 4-, and 8-year-old cohorts. The direct cost of infliximab with 24 hours of monitoring was $853 042, $899 096, and $1 024 101, respectively. A 20% bidirectional sensitivity analysis revealed stability of our model, with overall cost savings with use of infliximab. With monitoring 48 hours after infliximab treatment, 20% changes in length of stay (LOS) tipped the balance for the 2- and 4-year-old cohorts. Overall, IVIg and infliximab LOS had the most influence on our model.
Infliximab has potential to yield shorter LOS and significant cost savings in the treatment of rKD. Infliximab treatment, followed by 24 hours of monitoring, nearly halved hospital costs, regardless of age.
在 10%至 20%的病例中，川崎病对静脉注射免疫球蛋白（IVIg）无效，而这种药物目前处于国家短缺状态，价格昂贵。数据表明，英夫利昔单抗是 IVIg 二线治疗的可行选择，其疗效和安全性相当。我们比较了川崎病（KD）治疗中再次给予 IVIg 与英夫利昔单抗的成本。
采用决策分析模型比较 KD 治疗方案：再次给予 2 g/kg IVIg 与 10 mg/kg 英夫利昔单抗。英夫利昔单抗监测时间为 24、36 和 48 小时。根据 2016-2017 年 Truven MarketScan 数据，估计从 KD 确诊开始的直接医院费用。使用 Redbook 计算药物成本。将计算应用于 3 个假设的 100 名 2（12.5kg）、4（16kg）和 8 岁（25.5kg）患儿队列。间接成本包括父母旷工天数。
接受 IVIg 治疗的患儿总直接费用分别为 2 岁、4 岁和 8 岁组的 1 677 801 美元、1 791 652 美元和 2 100 675 美元。监测 24 小时后使用英夫利昔单抗的直接费用分别为 853 042 美元、899 096 美元和 1 024 101 美元。20%双向敏感性分析显示模型稳定，使用英夫利昔单抗可节省总体成本。在使用英夫利昔单抗治疗后监测 48 小时，2 岁和 4 岁患儿组的住院时间（LOS）变化 20%会改变平衡。总体而言，IVIg 和英夫利昔单抗 LOS 对我们的模型影响最大。
英夫利昔单抗在治疗 KD 时具有缩短 LOS 和显著节省成本的潜力。英夫利昔单抗治疗后监测 24 小时可显著降低医院成本，无论年龄大小，均接近减半。
