title: Pharmaceutical costs of desensitization therapy in patients awaiting lung transplantation in France.
abstract: BACKGROUND
  Based on solid experience in renal transplant, new treatments aiming to decrease anti-human leukocyte antigen (HLA) antibodies in patients awaiting lung transplant have recently been developed. The off-label use of high-dose intravenous polyvalent immunoglobulins (IVIg) and/or plasmapheresis changes the economical weight of pharmaceutical cost before lung transplantation.
  
  
  OBJECTIVE
  Our objective was to assess the budgetary impact of pharmaceutical costs of desensitization therapy.
  
  
  METHODS
  Two observational studies were conducted in 2009 and 2010 at the Bichat Claude Bernard (BCB) hospital in France. The first assessed the real pharmaceutical costs, and identified cost drivers, of desensitized (D+) patients awaiting lung transplantation. The second compared pharmaceutical and clinical data between D+ and non-treated (D-) patients.
  
  
  RESULTS
  The major cost drivers were IVIg, representing 89.7 % of pharmaceutical costs. The real cost of drugs was €4,392 ± 647 per hospitalization. Mean hospitalization and annual pharmaceutical costs per patient were significantly higher for D+ than for D- patients (€6,972 vs. 2,925 and €13,074 vs. 399). D+ patients had a significantly higher average number of annual hospitalizations than did D- patients. Total IVIg costs represented 98 % of the pharmaceutical costs for desensitization stays. Pharmaceutical costs represented 40 % of total hospitalization costs for D+ versus only 7 % for D-.
  
  
  CONCLUSIONS
  New desensitization protocols can help to manage the immunological hurdle of anti-donor antibodies in lung transplantation. They are expensive and not yet correctly covered by national health insurance, as they are supported by hospital budgets. A medico-economical evaluation of IVIg use in this indication seems necessary.
authors.affiliation: Department of Pharmacy, Bichat Claude Bernard Hospital, AP-HP, 146 rue Henri Huchard, 75877, Paris Cedex 18, France.
authors.forename: Annaë
authors.initials: A
authors.lastname: Liu
authors.forename: Mélisande
authors.initials: M
authors.lastname: Bernard
mesh_terms: D003365:Costs and Cost Analysis; D003888:Desensitization, Immunologic / Q000191:economics* / Q000379:methods; D005602:France; D006760:Hospitalization / Q000191:economics; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000191:economics* / Q000627:therapeutic use; D016040:Lung Transplantation
chemical_list: D016756:Immunoglobulins, Intravenous