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. 2022 Apr;23(3):551-558.
doi: 10.1007/s10198-021-01378-x. Epub 2021 Sep 21.

Cost-minimization analysis of immunoglobulin treatment of primary immunodeficiency diseases in Spain

Laia Alsina  1 , J Bruno Montoro #  2 , Pedro Moral Moral #  3 , Olaf Neth #  4 , Marta Ortiz Pica #  5 , Silvia Sánchez-Ramón #  6 , María Presa  7 , Itziar Oyagüez  7 , Miguel Ángel Casado  7 , Luis Ignacio González-Granado  8   9
Affiliations

Cost-minimization analysis of immunoglobulin treatment of primary immunodeficiency diseases in Spain

Laia Alsina et al. Eur J Health Econ. 2022 Apr.

Abstract

Primary immunodeficiency diseases (PID), which are comprised of over 400 genetic disorders, occur when a component of the immune system is diminished or dysfunctional. Patients with PID who require immunoglobulin (IG) replacement therapy receive intravenous IG (IVIG) or subcutaneous IG (SCIG), each of which provides equivalent efficacy. We developed a cost-minimization model to evaluate costs of IVIG versus SCIG from the Spanish National Healthcare System perspective. The base case modeled the annual cost per patient of IVIG and SCIG for the mean doses (per current expert clinical practice) over 1 year in terms of direct (drug and administration) and indirect (lost productivity for adults and parents/guardians of pediatric patients) costs. It was assumed that all IVIG infusions were administered in a day hospital, and 95% of SCIG infusions were administered at home. Drug costs were calculated from ex-factory prices obtained from local databases minus the mandatory deduction. Costs were valued on 2018 euros. The annual modeled costs were €4,266 lower for patients with PID who received SCIG (total €14,466) compared with those who received IVIG (total €18,732). The two largest contributors were differences in annual IG costs as a function of dosage (- €1,927) and hospital administration costs (- €2,688). However, SCIG incurred training costs for home administration (€695). Sensitivity analyses for two dose-rounding scenarios were consistent with the base case. Our model suggests that SCIG may be a cost-saving alternative to IVIG for patients with PID in Spain.

Keywords: Cost-minimization analysis; Immune system; Immunoglobulin replacement therapy; Intravenous immunoglobulin; Primary immunodeficiency disease; Subcutaneous immunoglobulin.

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Conflict of interest statement

J. Bruno Montoro reports grants and consultant fees from Biotest, CSL Behring, Grifols, Octapharma, and Shire, a Takeda company, during the conduct of the study. Olaf Neth has been an invited speaker for CSL Behring, Grifols, and Shire, a Takeda company. Marta Ortiz Pica reports research grants and consultant fees from Shire, a member of the Takeda group of companies. Laia Alsina has been an invited speaker for Binding Site, CSL Behring, and Shire, a Takeda company. Luis Ignacio González-Granado has been an invited speaker for CSL Behring and Shire, a Takeda company. Silvia Sánchez-Ramón has served as speaker, consultant, and advisory board member for, or has received research funding from, Biotest, CSL Behring, Grifols, Octapharma, and Shire, a Takeda company. Itziar Oyagüez, Miguel Ángel Casado, and María Presa are employees of Pharmacoeconomics and Outcomes Research Iberia, a consultant company specialized in economic evaluation of health technologies, which has received unrestricted funding for development of the analysis. No funding has been received in relation with the authorship of the present manuscript. Pedro Moral Moral reports no competing interests.

Figures

Fig. 1
Fig. 1
Structure of the cost-minimization analysis model. IVIG intravenous immunoglobulin, PID primary immunodeficiency diseases, SCIG subcutaneous immunoglobulin
See this image and copyright information in PMC

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