Cost-minimisation analysis of plasma exchange versus IVIg in the treatment of autoimmune neurological conditions

• Published in: BMC health services research 2022-07, Vol.22 (1), p.1-904, Article 904
• Main Authors: Klemencic Kozul, Tara, Yudina, Anna, Donovan, Carley, Pinto, Ashwin, Osman, Chinar
• Format: Article
• Language: English
• Subjects: Analysis; Antibodies; Anticoagulants; Apheresis; Autoimmune neurological disorders; Care and treatment; Cost effectiveness; Cost-minimisation; Costs; COVID-19; Diagnosis; Encephalitis; Guillain-Barre syndrome; Health services; Immunoglobulins; Intensive care; Intravenous immunoglobulin (IVIg); Medical care, Cost of; Nervous system diseases; Neurological disorders; Neurology; Patient outcomes; Patients; Pharmacists; Plasma; Plasma exchange (PLEX); Plasma exchange (Therapeutics); Risk factors; Venous access
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-022-08210-z

Background Plasma exchange (PLEX) is an effective treatment for antibody-mediated neurological disorders and has been shown to be equally efficacious to intravenous immunoglobulin (IVIg) with comparable adverse event profiles. IVIg has traditionally been the preferred treatment option due to its ease of use. However, advancing technology has allowed PLEX to be performed with a centrifugal system via peripheral access as opposed to central access via a membrane filter. Methods We prospectively collected data from a cohort of patients who underwent PLEX at the Wessex Neurological Centre, UK, to perform a cost-minimisation analysis comparing PLEX to IVIg, the standard of care, between May 2019 and May 2020. Data obtained included indication, admission type (inpatient, daycase or intensive care), access (peripheral or central), number of PLEX cycles, exchange volume, patient weight, complications and clinical outcomes. The cost of PLEX delivered in an outpatient setting for an average 80kg person was calculated and compared to the equivalent cost of delivering IVIg by means of a cost-minimization model. Results The provision of PLEX was roughly half as costly when compared to what it would have been for IVIg ([pounds sterling]886 per exchange vs [pounds sterling]1778 per infusion or [pounds sterling]4432 per cycle of 5 exchanges vs [pounds sterling]8890 per cycle of 5 infusions). Our cohort included a total of 44 patients who received a total of 357 PLEX exchanges during the 12-month period (the majority of which were in a daycase setting). We calculated an annual cost saving for PLEX over IVIg of [pounds sterling]318,589. The robustness of this result was confirmed by a one-way deterministic sensitivity analysis, showing the cost-effectiveness of PLEX. Conclusion Our findings demonstrate that PLEX is more cost-effective than IVIg in this setting. Our study supports the economic case for development of plasma exchange centres in regional neurology units, a case made all the more relevant in the context of constrained supplies of IVIg. Keywords: Plasma exchange (PLEX), Intravenous immunoglobulin (IVIg), Cost-minimisation, Autoimmune neurological disorders, Cost effectiveness