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COST‐BENEFIT RATIO OF INTRAVENOUS IMMUNOGLOBULIN TREATMENT IN CHRONIC INFLAMMATORY DEMYELINATING POLYRADICULONEUROPATHY
Author(s) -
Gragnani F.,
Ceschin V.,
Morino S.,
Clemenzi A.,
Soscia F.,
Gozzer M.,
Rusignuolo A.,
Antonini G.
Publication year - 2000
Publication title -
journal of the peripheral nervous system
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1
H-Index - 67
eISSN - 1529-8027
pISSN - 1085-9489
DOI - 10.1046/j.1529-8027.2000.00513-27.x
Subject(s) - medicine , polyradiculoneuropathy , chronic inflammatory demyelinating polyneuropathy , surgery , antibody , physical therapy , pediatrics , guillain barre syndrome , immunology
Intravenous immunoglobulin (IVIG) is considered an efficacious but expensive treatment in dysimmune polyneuropathies. Nevertheless, to date, no studies have been conducted on the cost of this therapy. We retrospectively studied 21 patients affected by chronic inflammatory demyelinating polyradiculoneuropathy (idiopathic‐CIDP and CIDP‐MGUS), comparing the clinical response and costs of IVIG therapy with those of plasma exchange (PE). Patients were treated either with IVIG (400 mg/Kg/die for five days) or PE (6 exchanges in 3 weeks). Responders continued the same therapy, which was progressively tapered down to one IVIG infusion or one PE monthly. IVIG nonresponders received PE and vice versa. Patients were followed for a period ranging from 3 to 67 months (median: 29 months). The modified Rankin disability scale was used to determine functional impairment at baseline and during treatment. Eleven of 21 patients (52%) improved with the first choice of treatment. Of the remaining 10 patients, 3 benefited from the alternative treatment; 2 patients who did not respond to the alternative treatment were again treated with the first choice therapy and subsequently improved; 2 patients on IVIG abandoned the therapy. One nonresponder to IVIG is currently receiving PE. The overall response rate to the two therapies was similar. The mean cost per patient was 1,128,000 lire/session for PE therapy (excluding equipment and medical staff costs) and 1,204,000 lire/dose for IVIG therapy. However, the responders to PE required a longer treatment than responders to IVIG.