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Cost Eff Resour Alloc. 2010 Jun 17;8:14. doi: 10.1186/1478-7547-8-14.

Cost-utility of Intravenous Immunoglobulin (IVIG) compared with corticosteroids for the treatment of Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) in Canada.

Cost effectiveness and resource allocation : C/E

Gord Blackhouse, Kathryn Gaebel, Feng Xie, Kaitryn Campbell, Nazila Assasi, Jean-Eric Tarride, Daria O'Reilly, Colin Chalk, Mitchell Levine, Ron Goeree

Affiliations

  1. PATH Research Institute, McMaster University, Hamilton, Ontario, Canada. [email protected].

PMID: 20565778 PMCID: PMC2903512 DOI: 10.1186/1478-7547-8-14

Abstract

OBJECTIVES: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: Based on common willingness to pay thresholds, IVIG would not be perceived as a cost effective treatment for CIDP.

References

  1. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD004429 - PubMed
  2. J Rheumatol. 1994 Jul;21(7):1207-13 - PubMed
  3. Ann Neurol. 2001 Aug;50(2):195-201 - PubMed
  4. Neurology. 1990 Feb;40(2):327-8 - PubMed
  5. Ann Neurol. 1982 Feb;11(2):136-41 - PubMed
  6. Neurology. 1990 Feb;40(2):209-12 - PubMed
  7. Control Clin Trials. 1986 Sep;7(3):177-88 - PubMed
  8. Transfus Med Rev. 2007 Apr;21(2 Suppl 1):S9-56 - PubMed
  9. Neurology. 2001 Feb 27;56(4):445-9 - PubMed
  10. Rheumatology (Oxford). 2003 Jan;42(1):46-53 - PubMed
  11. J Neurol. 1996 Mar;243(3):280-5 - PubMed
  12. J Neurol Neurosurg Psychiatry. 1999 May;66(5):677-80 - PubMed
  13. Neurol Clin. 2007 Feb;25(1):71-87 - PubMed
  14. Brain. 1996 Aug;119 ( Pt 4):1067-77 - PubMed
  15. Ann Neurol. 1994 Dec;36(6):838-45 - PubMed
  16. Eur J Neurol. 2003 Nov;10(6):687-94 - PubMed
  17. Trans Am Ophthalmol Soc. 2001;99:301-17 - PubMed
  18. Lancet Neurol. 2008 Feb;7(2):136-44 - PubMed
  19. Ann Neurol. 1999 Dec;46(6):910-3 - PubMed
  20. Am J Med. 1994 Feb;96(2):115-23 - PubMed
  21. Curr Med Res Opin. 2006 Jul;22(7):1425-36 - PubMed
  22. J Neurol Neurosurg Psychiatry. 1993 Jan;56(1):36-9 - PubMed
  23. Transfus Apher Sci. 2005 Nov;33(3):317-24 - PubMed
  24. Can J Ophthalmol. 2008 Apr;43(2):213-7 - PubMed

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