title: Economic benefits of subcutaneous rapid push versus intravenous immunoglobulin infusion therapy in adult patients with primary immune deficiency.
abstract: OBJECTIVE
  The objective of this study is to evaluate the economic benefits of immunoglobulin replacement therapy achieved subcutaneously (subcutaneous immunoglobulin, SCIG) by the rapid push method compared to intravenous infusion therapy (intravenous immunoglobulin, IVIG) in primary immune deficiency (PID) patients from the healthcare system perspective in the context of the adult SCIG home infusion program based at St Paul's Hospital, Vancouver, Canada.
  
  
  METHODS
  SCIG and IVIG options were compared in cost-minimisation and budget impact models (BIMs) over 3 years. Sensitivity analyses were performed for both models to evaluate the impact of varying modality of IVIG treatments and proportion of patients switching from IVIG to SCIG.
  
  
  RESULTS
  The cost-minimisation model estimated that SCIG treatment reduced cost to the healthcare system per patient of $5736 over 3 years, principally because of less use of hospital personnel. This figure varied between $5035 and $8739 depending on modality of IVIG therapy. Assuming 50% of patients receiving IVIG switched to SCIG, the BIM estimated cost savings for the first 3 years at $1·308 million or 37% of the personnel and supply budget. These figures varied between $1·148 million and $2·454 million (36 and 42%) with varying modalities of IVIG therapy. If 75% of patients switched to SCIG, the reduced costs reached $1·962 million or 56% of total budget.
  
  
  CONCLUSIONS
  This study demonstrated that from the health system perspective, rapid push home-based SCIG was less costly than hospital-based IVIG for immunoglobulin replacement therapy in adult PID patients in the Canadian context.
authors.affiliation: St Paul's Hospital, Vancouver, BC.
authors.forename: A
authors.initials: A
authors.lastname: Martin
authors.affiliation: The LA-SER Group, Montreal.
authors.forename: L
authors.initials: L
authors.lastname: Lavoie
authors.affiliation: The LA-SER Group, Montreal.
authors.forename: M
authors.initials: M
authors.lastname: Goetghebeur
authors.affiliation: St Paul's Hospital, Vancouver, BC.|Department of Medicine, James Hogg iCapture Centre for Cardiovascular and Pulmonary Research, University of British Columbia, Vancouver, BC, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Schellenberg
mesh_terms: D000328:Adult; D001955:British Columbia; D002017:Budgets / Q000706:statistics & numerical data; D017046:Cost Savings / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data; D018575:Home Care Services, Hospital-Based / Q000191:economics; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007116:Immunization, Passive / Q000191:economics / Q000379:methods*; D016756:Immunoglobulins, Intravenous / Q000191:economics / Q000627:therapeutic use*; D007153:Immunologic Deficiency Syndromes / Q000191:economics / Q000628:therapy*; D007262:Infusions, Intravenous / Q000191:economics; D007279:Injections, Subcutaneous / Q000191:economics; D012456:Salaries and Fringe Benefits / Q000706:statistics & numerical data
chemical_list: D016756:Immunoglobulins, Intravenous