Cost analysis of treatment with therapeutic plasma exchange versus treatment with intravenous immunoglobulins in patients with immune-based neurological diseases. Proposal for optimising the use of plasmatic blood products

Abstract

Introduction

Therapeutic plasma exchange (TPE) and/or the administration of endovenous immunoglobulins (IGEV) are considered the first line treatment for multiple autoimmune-based neurological diseases. According to the scientific evidence collected in several recent guidelines, the efficacy of both treatments is very similar for many of them, however, the current situation of non-self-sufficiency and the real risk of IGEV shortages make it essential to assess TPE as the first therapeutic option.

The objective of this work is to estimate the basic direct costs derived from treatment with RPT compared to treatment with IGEV in immune-mediated neurological diseases in a situation of supposed therapeutic equivalence.

Material and methods

Patients who are treated with IGEV receive a standard dose of 0.4 g/kg weight for 5 consecutive days. Patients treated with RPT with the Terumo-BCT® Optia model cell separator undergo between 5 and 7 sessions, every other day, with a substitution equivalent to 1–1.5 volumes, using 4%–5% albumin as replacement fluid. The calculation of the economic cost, for both types of treatments, in simulation of therapeutic equivalence and safety, has been carried out considering pharmaceutical expenses, calculation of the cost for each dose of IGEV, the detailed costs of consumables, replacement fluids and anticoagulant for RPT, in the worst-case scenario, with central venous catheter (CVC) placement. The price of albumin and immunoglobulins has been adjusted based on the situation of self-sufficiency or dependency and the average value of the last 4 years has been referenced for the calculations. The costs of personnel, hospitalisation, or complications derived from the treatments have not been considered. The prices are indicated in euros including VAT of 4% or 21% as appropriate.

Results

For a patient with a mean weight of 70 kg, the estimated final cost per TPR session, with CVC placement, was €612.66; while the cost for each dose of IGEV. (0.4 g/kg) was €1191. The difference is favorable to the RPT: €2279 [€1,666.4–€2,891.7]. The economic difference presented is probably greater in real clinical practice, since many of the patients do not require CVC placement to perform the TPR, and sessions were performed on an outpatient basis.

Conclusions

The use of TPE in the first line in pathologies in which the clinical results do not present significant differences with the IGEV, optimises the use of blood products and can lead to economic savings. It is necessary to expand this study by including an analysis of the efficacy in our series, as well as the adverse events associated with each type of treatment together with other expenses derived from personnel and hospital admission costs versus the use of outpatient resources (pheresis room).