Clinical and economic outcomes of a "high-touch" clinical management program for intravenous immunoglobulin therapy

• Published in: ClinicoEconomics and outcomes research 2018-01, Vol.10, p.1-12
• Main Authors: Zhu, Julia, Kirkham, Heather S, Ayer, Gretchen, Chen, Chi-Chang, Wade, Rolin L, Karkare, Swapna U, Robson, Chester H, Orange, Jordan S
• Format: Article
• Language: English
• Subjects: Algorithms; Analysis; Bacterial infections; Clinical Outcomes; Costs; Drug dosages; Economic Outcomes; Evidence-based medicine; Headaches; Health care costs; Health insurance; Hospitals; Immunoglobulin; Immunoglobulins; Infection; Infections; Intravenous; Management Program; Medical economics; Medical research; Original Research; Patient education; Pharmacists; Pharmacy; Prevention; Quality of life; Studies; Treatment outcome; Trends
• ISSN: 1178-6981; 1178-6981
• DOI: 10.2147/CEOR.S142239

To compare clinical and economic outcomes of patients who received intravenous immunoglobulin (IVIG) therapies and were managed by a clinical management program vs the outcomes of matched controls using administrative claim data. This retrospective cohort study used the PharMetrics Plus™ claim database between September 1, 2011 and June 30, 2014. Patients in the intervention group were from a "high-touch" IVIG clinical management program administered by a home infusion specialty pharmacy. A greedy propensity score matching algorithm was used to identify a control group from non-program patients. Generalized estimating equation models were employed to evaluate differences between cohorts who were followed for 1 year. Clinical outcomes were measured as infections and infusion-related adverse events. The proportion of patients who had serious bacterial infections was significantly lower (4.13% vs 7.75%, =0.049) in the intervention group (n=242) compared to the control group (n=968). Other clinical outcomes assessed were not different between cohorts ( >0.050). The economic outcomes were measured as healthcare costs. The annual adjusted mean total health care costs of patients in the program were $26,522 lower compared to matched controls, representing a 20% lower cost ($109,476 vs $135,998, =0.002). A major contribution to this difference ($17,269) was IVIG-related total outpatient cost (intervention vs control groups: $64,080 vs $81,349, =0.001). The patients in this high-touch IVIG clinical management program appeared to have comparable infections or adverse event rates and significantly lower total health costs compared to their matched controls.