Intravenous immunoglobulin utilization in the Canadian Atlantic provinces: a report of the Atlantic Collaborative Intravenous Immune Globulin Utilization Working Group.
BACKGROUND
Intravenous immunoglobulin (IVIG) use for labeled and unlabeled indications is growing steadily. By use of a collaborative regional strategy, baseline IVIG usage and appropriateness of utilization were determined for Atlantic Canada. The effectiveness of strategies designed to optimize utilization was also studied.


METHODS
A regional working group was created to monitor IVIG utilization for a 2-year period in the four Canadian Atlantic Provinces. A registry of IVIG was created. Assessment of indication appropriateness was determined with national and provincial guidelines along with expert clinical opinion. To optimize IVIG use, IVIG guidelines and feedback reports were distributed to stakeholders. Appropriateness of IVIG use was compared over the course of the study.


RESULTS
The leading indications for IVIG use were idiopathic thrombocytopenic purpura (17.3%), primary immune deficiency conditions (14.9%), and chronic idiopathic demyelinating polyneuropathy (11.8%). The leading prescribing specialists were neurologists (32.2%) and hematologists (26.1%). A total of 37.1 percent of IVIG usage was in accordance with labeled indications. After optimization strategies were implemented, there was little change in labeled use. There was a 4.2 percent decrease in unlabeled use not supported by evidence (p<0.001).


CONCLUSIONS
A regional collaborative strategy for monitoring IVIG use was established. Most of the IVIG use was for labeled or appropriate indications. The majority of unlabeled use was supported by the medical literature. Strategies to optimize IVIG utilization were associated with a decrease in inappropriate IVIG use and a plateau in IVIG utilization compared to the rest of the country.
Constantine
Maggie M
MM
Capital District Health Authority and the Nova Scotia Provincial Blood Coordinating Program, Halifax, Nova Scotia, Canada.
Thomas
Wanda
W
Whitman
Lucinda
L
Kahwash
Eiad
E
Dolan
Sean
S
Smith
Susan
S
Caudle
Christopher J
CJ
Burton
Erica
E
Anderson
David R
DR
D002170:Canada; D003299:Cooperative Behavior; D003625:Data Collection; D004348:Drug Labeling; D017723:Drug Utilization Review; D006402:Hematologic Diseases / Q000188:drug therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000191:economics / Q000627:therapeutic use*; D011129:Polyradiculoneuropathy / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy; D012042:Registries
D016756:Immunoglobulins, Intravenous