title: Cost-minimization analysis of the direct costs of TPE and IVIg in the treatment of Guillain-Barré syndrome.
abstract: BACKGROUND
  Controlled trials have found therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIg) infusion therapy to be equally efficacious in treating Guillain-Barré syndrome (GBS). Due to increases in the price of IVIg compared to human serum albumin (HSA), used as a replacement fluid in TPE, we examined direct hospital-level expenditures for TPE and IVIg for meaningful cost-differences between these treatments.
  
  
  METHODS
  Using financial data from our two institutions, hospital cost profiles for IVIg and 5% albumin were established. Reimbursement amounts were obtained from publicly available Medicare data resources to determine payment rates for TPE, non-tunneled central catheter line placement, and drug infusion therapy. A model was developed which allows hospitals to input cost and reimbursement amounts for both IVIg and TPE with HSA that results in real-time valuations of these interventions.
  
  
  RESULTS
  The direct cost of five IVIg infusion sessions totaling 2.0 grams per kilogram (g/kg) body weight was $10,329.85 compared to a series of five TPE procedures, which had direct costs of $4,638.16.
  
  
  CONCLUSIONS
  In GBS patients, direct costs of IVIg therapy are more than twice that of TPE. Given equivalent efficacy and similar severity and frequencies of adverse events, TPE appears to be a less expensive first-line therapy option for treatment of patients with GBS.
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First ST SW, Rochester, MN 55905, USA. winters.jeffrey@mayo.edu
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Winters
authors.forename: David
authors.initials: D
authors.lastname: Brown
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Hazard
authors.forename: Ashok
authors.initials: A
authors.lastname: Chainani
authors.forename: Chester
authors.initials: C
authors.lastname: Andrzejewski
mesh_terms: D016001:Confidence Intervals; D017046:Cost Savings / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D004469:Economics, Hospital / Q000706:statistics & numerical data*; D020275:Guillain-Barre Syndrome / Q000188:drug therapy / Q000191:economics* / Q000628:therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000191:economics* / Q000627:therapeutic use; D010951:Plasma Exchange / Q000191:economics*; D012709:Serum Albumin / Q000191:economics*; D014481:United States
chemical_list: D016756:Immunoglobulins, Intravenous; D012709:Serum Albumin