Open AccessHome versus hospital immunoglobulin treatment for autoimmune neuropathies: A cost minimization analysis
Author(s) -
Le Masson Gwendal,
Solé Guilhem,
Desnuelle Claude,
Delmont Emilien,
GauthierDarnis Marc,
Puget Sophie,
DurandZaleski Isabelle
Publication year - 2018
Publication title -
brain and behavior
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.915
H-Index - 41
ISSN - 2162-3279
DOI - 10.1002/brb3.923
Subject(s) - medicine , multifocal motor neuropathy , polyradiculoneuropathy , cost minimization analysis , quality of life (healthcare) , clinical endpoint , clinical trial , chronic inflammatory demyelinating polyneuropathy , pediatrics , physical therapy , antibody , mismatch negativity , guillain barre syndrome , immunology , nursing , electroencephalography , psychiatry
Background Prior clinical trials have suggested that home‐based Ig treatment in multifocal motor neuropathy ( MMN ) and chronic inflammatory demyelinating polyradiculoneuropathy ( CIDP ) and its variant Lewis–Sumner syndrome ( LSS ) is safe and effective and is less costly than hospital‐administered intravenous immunoglobulin ( IVI g). Methods A French prospective, dual‐center, cost minimization analysis was carried out to evaluate IVI g administration (5% concentrated) at home versus in hospital with regard to costs, patients’ autonomy, and patients’ quality of life. The primary endpoint was the overall cost of treatment, and we adopted the perspective of the payer (French Social Health Insurance). Results Twenty‐four patients aged 52.3 (12.2) years were analyzed: nine patients with MMN , eight with CIDP , and seven with LSS . IVI g (g/kg) dosage was 1.51 ± 0.43 in hospital and 1.52 ± 0.4 at home. Nine‐month total costs per patient extrapolated to 1 year of treatment were €48,189 ± 26,105 versus €91,798 ± 51,125 in the home and hospital groups, respectively ( p < .0001). The most frequently reported factors for choosing home treatment were the good tolerance and absence of side effects of IVI g administration, as well as a good understanding of the advantages and drawbacks of home treatment (75% of respondents). The mR ankin scores before and after switch to home treatment were 1.61 ± 0.72 and 1.36 ± 0.76, respectively ( p = .027). Discussion The switch from hospital‐based to home‐based IVI g treatment for patients with immune neuropathy represents potentially significant savings in the management of the disease.