RESUMEN
Objective: The aim of this study was to evaluate the administration of intravenous immunoglobulin (IVIg) solutions (5% vs. 10%) in hematological patients suffering from a secondary immunodeficiency (SID) to optimize infusion duration and hospitalization time. Design: A monocentric, observational study in 30 patients with secondary hypogammaglobulinemia due to a lymphoproliferative disorder currently under IVIg 5% treatment. A sequential approach was followed with observations during IVIg 5% and 10% administration 3 to 4 weeks later. Infusion time, time spent at the day clinic, IVIg-related adverse events and number of actions taken by the nursing staff were evaluated and compared between the 5% and 10% infusions. Questionnaires for patients and nursing staff were obtained after IVIg 10% to assess their satisfaction with the change of infusion. Results: Average infusion time was reduced from 4.92 h to 2.29 h (p < 0.0001). Time spent at the day clinic was 5.87 h for the 5% IVIg administration and 4.56 h for the 10% (p = 0.0005). IVIg-related adverse events rose from 0 to 0.43 per patient. No serious adverse events were reported. Nursing actions per patient decreased from 1.03 to 0.67. Patient and nursing satisfaction were respectively 83% and 96% in favor of IVIg 10%. Conclusion: A 10% IVIg solution can significantly reduce infusion time and overall duration of the day clinic visit. Care must be taken to minimize new infusion-related adverse events. Switching to a 10% IVIg administration increases patient and nursing satisfaction but also requires additional workflow changes to further shorten the day clinic visit.
Asunto(s)
Agammaglobulinemia , Inmunoglobulinas Intravenosas/administración & dosificación , Trastornos Linfoproliferativos/complicaciones , Adulto , Agammaglobulinemia/tratamiento farmacológico , Agammaglobulinemia/epidemiología , Agammaglobulinemia/etiología , Agammaglobulinemia/enfermería , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Inmunoglobulinas Intravenosas/efectos adversos , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Resultado del TratamientoRESUMEN
Lifelong immunoglobulin replacement is the standard, expensive therapy for severe primary antibody deficiencies. This treatment can be administrated either by intravenous immunoglobulin (IVIG) or subcutaneous infusions (SCIG) and delivered at home or in an out-patient setting. This study aims to determine whether SCIG is cost-effective compared with IVIG from a French social insurance perspective. Because both methods of administration provide similar efficacies, a cost-minimization analysis was performed. First, costs were calculated through a simulation testing different hypothesis on costs drivers. Secondly, costs were estimated on the basis of field data collected by a questionnaire completed by a population of patients suffering from agammaglobulinaemia and hyper-immunoglobulin (Ig)M syndrome. Patients' satisfaction was also documented. Results of the simulation showed that direct medical costs ranged from 19 484 euro for home-based IVIG to 25 583 euro for hospital-based IVIG, with home-based SCIG in between at 24 952 euro per year. Estimations made from field data were found to be different, with significantly higher costs for IVIG. This result was explained mainly by a higher immunoglobulin mean dose prescribed for IVIG. While the theoretical model showed very little difference between SCIG and hospital-based IVIG costs, SCIG appears to be 25% less expensive with field data because of lower doses used in SCIG patients. The reality of the dose difference between both routes of administration needs to be confirmed by further and more specific studies.