Selective high dose gamma-globulin treatment in Kawasaki disease: assessment of clinical aspects and cost effectiveness

• Published in: Pediatrics international 1999-02, Vol.41 (1), p.1-7
• Main Authors: Sato, N, Sugimura, T, Akagi, T, Yamakawa, R, Hashino, K, Eto, G, Iemura, M, Ishii, M, Kato, H
• Format: Article
• Language: English
• Subjects: Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Aspirin - therapeutic use; C-Reactive Protein - metabolism; Coronary Disease - etiology; Coronary Disease - prevention & control; Cost-Benefit Analysis; Decision Trees; Drug Costs; Drug Therapy, Combination; Female; gamma-Globulins - economics; gamma-Globulins - therapeutic use; Humans; Immunization, Passive; Immunoglobulins, Intravenous - economics; Immunoglobulins, Intravenous - therapeutic use; Infant; Length of Stay - statistics & numerical data; Male; Mucocutaneous Lymph Node Syndrome - blood; Mucocutaneous Lymph Node Syndrome - complications; Mucocutaneous Lymph Node Syndrome - immunology; Mucocutaneous Lymph Node Syndrome - therapy; Patient Selection; Severity of Illness Index
• ISSN: 1328-8067; 1442-200X
• DOI: 10.1046/j.1442-200x.1999.t01-1-01014.x

High-dose intravenous gamma-globulin (IVGG) plus aspirin (ASA) treatment is effective in preventing coronary artery complications in acute Kawasaki disease (KD). However, gamma-globulin is very expensive, especially in Japan. Furthermore the indication for IVGG treatment and the optimal dose of gamma-globulin remain controversial. To examine these two issues, we used Harada's scoring system to investigate whether a single 2 g/kg dose therapy has any advantage over the 5 day 400 mg/kg per day therapy. We studied 203 patients with KD who had no coronary artery complications on admission. Of these, 145 patients scored 4 or more on Harada score within the first 9 days of illness and were treated with IVGG treatment. Using a random number table, 72 patients were selected to receive a single 2 g/kg dose (2 g group), while the remaining 73 patients were treated with 400 mg/kg per day for 5 consecutive days (400 mg group). Those who had a Harada score of three or less received no IVGG (non-IVGG group) treatment (58 patients). The incidence rate of coronary artery complications in the 2 g group was significantly lower than in the 400 mg group. The duration of high fever, positive duration of C-reactive protein and the number of hospital days in the 2 g group were each significantly shorter than in the 400 mg group. The total medical expense in the 2 g group was significantly lower than in the 400 mg group. There were no coronary artery complications in the non-IVGG group. It was found to be clinically more effective and more cost effective to select a patient by Harada's scoring system and, where a score of four or more was obtained, to administer a single 2 g/kg intravenous dose of gamma-globulin for acute KD.