Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
Pharmacy Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Eur J Health Econ. 2022 Apr;23(3):551-558. doi: 10.1007/s10198-021-01378-x. Epub 2021 Sep 21.
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.
原发性免疫缺陷病（PID）由超过 400 种遗传疾病组成，当免疫系统的某个组成部分减弱或功能失调时就会发生。需要免疫球蛋白（IG）替代疗法的 PID 患者接受静脉内免疫球蛋白（IVIG）或皮下免疫球蛋白（SCIG）治疗，这两种治疗方法的疗效相当。我们开发了一个成本最小化模型，从西班牙国家医疗保健系统的角度评估 IVIG 与 SCIG 的成本。基础案例以当前专家临床实践中的平均剂量为基础，对患者接受 IVIG 和 SCIG 的每年每位患者成本进行建模，包括直接（药物和管理）和间接（成人和儿科患者父母/监护人的生产力损失）成本。假设所有 IVIG 输注都在日间医院进行，95%的 SCIG 输注都在家中进行。药物成本是根据从当地数据库获得的出厂价格减去强制性扣除额计算得出的。成本按 2018 年欧元计价。接受 SCIG（总计 14466 欧元）的 PID 患者的年度模型成本比接受 IVIG（总计 18732 欧元）的患者低 4266 欧元。两个最大的贡献因素是剂量相关的年度 IG 成本差异（-1927 欧元）和医院管理成本差异（-2688 欧元）。然而，SCIG 会产生家庭管理的培训成本（695 欧元）。两种剂量舍入方案的敏感性分析与基础案例一致。我们的模型表明，对于西班牙的 PID 患者，SCIG 可能是一种比 IVIG 更节省成本的替代方案。
