Economic evaluation of intravenous immune globulin therapy for Kawasaki syndrome.
OBJECTIVE
To determine the costs and clinical outcomes of three alternative treatments of the acute phase of Kawasaki syndrome: aspirin alone; low doses of intravenously administered immune globulin (IVIG-LD), 400 mg/kg per dose for 4 days; and high doses of intravenously administered immune globulin (IVIG-HD), 2.0 gm/kg for one dose.


METHODS
A model was developed that assumed the inclusion of 100 patients with acute Kawasaki syndrome in each treatment option. Costs were valued by using the Chedoke-McMaster Corporate Cost Model in 1992 Canadian dollars. Clinical outcome, based on the published literature, was measured by the prevalence of coronary artery dilation at 7 weeks from the diagnosis of Kawasaki syndrome.


RESULTS
For every 100 patients with Kawasaki syndrome, the cost was reduced by $323,400 when aspirin therapy alone was changed to IVIG-HD therapy and 14 cases of coronary artery dilation were thereby prevented. When IVIG-HD therapy was compared with IVIG-LD therapy, the cost was reduced by $118,200 because two cases of coronary artery aneurysm were prevented. This latter result was sensitive to the duration of hospitalization, with IVIG-HD costing $8500 more for every 100 patients than IVIG-LD when it was assumed that both groups were hospitalized for 5 days, an unlikely occurrence.


CONCLUSIONS
Treatment with IVIG-HD for Kawasaki syndrome is preferred because it results in both lower costs and lower rates of coronary artery dilation.
Klassen
T P
TP
Department of Pediatrics, University of Ottawa, Ontario, Canada.
Rowe
P C
PC
Gafni
A
A
D001241:Aspirin / Q000191:economics / Q000627:therapeutic use; D002648:Child; D003327:Coronary Disease / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004467:Economics; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000191:economics* / Q000627:therapeutic use*; D007902:Length of Stay / Q000191:economics; D009080:Mucocutaneous Lymph Node Syndrome / Q000191:economics* / Q000628:therapy*; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous; D001241:Aspirin