1. Self-administered subcutaneous immunoglobulin therapy in the treatment of immunodeficiencies is significantly less costly compared to clinic-administered intravenous immunoglobulin therapy.
Evidence Rating Level: 2 (Good)
Immunoglobulin G (IgG) can be administered in intravenous (IVIG) or subcutaneous (SCIG) form to treat immunodeficiency diseases. IVIG is typically performed once monthly in an out-patient setting and administered by a nurse. While IVIG and SCIG cannot be always interchanged, a newer alternative method of SCIG can be self-administered at home. Preliminary studies have suggested that self-administered SCIG was less costly compared to nurse-administered IVIG. In this population-based cohort study conducted in Alberta, Canada, data was used to compare the health care cost-effectiveness of self-administered SCIG compared to clinic-administered IVIG. The cohort in this study consisted of 7 890 patients who received at least one dose of an IgG therapeutic product during the observational period. The results of this study showed that the overall mean patient-year cost of self-administered SCIG, including preparation and dispensation costs, was $817 while cost of clinic-administered IVIG was $6204 (mean difference $5386, 95%CI $5039-5734). This study suggests that an estimated $31 million in cost savings would occur if at least 80% of individuals switched from clinic-administered IVIG to self-administered SCIG. In conclusion, this paper reports that self-administered SCIG in treating immunodeficiencies would be significantly less expensive for the health care system compared to clinic-administered IVIG, ultimately resulting in a reduction of nursing burden and increasing clinic capacity for other patients. However, it is important to note that while this study does compare SCIG to IVIG, the overall effectiveness of both modalities may not be similar. Additionally, this study was conducted specifically in the context of the Canadian health care system and does not account for immunoglobulin therapy in other locations. Nevertheless, the findings of this study are promising in reducing health care burden of treating patients with immunodeficiencies.
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