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


OBJECTIVE
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.


METHODS
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).


RESULTS
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.


CONCLUSIONS
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.
Sato
N
N
Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan.
Sugimura
T
T
Akagi
T
T
Yamakawa
R
R
Hashino
K
K
Eto
G
G
Iemura
M
M
Ishii
M
M
Kato
H
H
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D003327:Coronary Disease / Q000209:etiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D016527:Drug Costs; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007116:Immunization, Passive; D016756:Immunoglobulins, Intravenous / Q000191:economics / Q000627:therapeutic use*; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000097:blood / Q000150:complications / Q000276:immunology / Q000628:therapy*; D018579:Patient Selection; D012720:Severity of Illness Index; D005719:gamma-Globulins / Q000191:economics / Q000627:therapeutic use*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016756:Immunoglobulins, Intravenous; D005719:gamma-Globulins; D002097:C-Reactive Protein; D001241:Aspirin