Bruce Ritchie, Karen J B Martins, Dat T Tran, Heather Blain, Lawrence Richer, Scott W Klarenbach
{"title":"在加拿大阿尔伯塔省，自体皮下注射与临床静脉注射免疫球蛋白G治疗的经济影响:一项基于人群的队列研究。","authors":"Bruce Ritchie, Karen J B Martins, Dat T Tran, Heather Blain, Lawrence Richer, Scott W Klarenbach","doi":"10.1186/s13223-022-00735-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Self-administered subcutaneous immunoglobulin G (SCIg) reduces nursing time and eliminates the need for treatment at ambulatory care clinics, as compared with clinic-based intravenously administered IgG (IVIg), and are therapeutically equivalent. Estimating the economic impact of self-administered SCIg versus clinic-administered IVIg therapy may guide treatment recommendations.</p><p><strong>Methods: </strong>A retrospective population-based cohort study using administrative data from Alberta was performed; those treated with IgG between April 1, 2012 and March 31, 2019 were included. Costs for medical laboratory staff and nursing time, as well as ambulatory care visits were considered. Univariate generalized linear model regression with gamma distribution and log link was used to compare cost ($CDN 2020) between SCIg and IVIg administration. Stratified analysis by age (≥ 18-years; < 18-years) was performed.</p><p><strong>Results: </strong>Among 7,890 (6,148 adults; 1,742 children) individuals who received IgG, the average administration cost per patient-year of self-administered SCIg was $5,386 (95% confidence interval [CI] $5,039, $5,734) lower than clinic-administered IVIg; per patient-year cost of self-administered SCIg was $817 (95% CI $723, $912) versus $6,204 (95% CI $6,100, $6,308) for clinic-administered IVIg. The per patient-year cost of self-administered SCIg was $5,931 (95% CI $5,543, $6,319) lower among adults and $3,177 (95% CI $2,473, $3,882) lower among children compared with clinic-administered IVIg. An estimated $31.0 million (95% CI $29.0, $33.0) in cost savings to the health system would be realised if 80% of individuals switched from clinic-administered IVIg to self-administered SCIg.</p><p><strong>Conclusions: </strong>Self-administered SCIg is substantially less costly from a health care payer perspective in Canada. Within this type of health system, switching to self-administered SCIg has the potential to reduce overall health care costs, lessen nursing burden, and may increase clinic-based capacity for others.</p>","PeriodicalId":7702,"journal":{"name":"Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology","volume":"18 1","pages":"99"},"PeriodicalIF":0.0000,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9700869/pdf/","citationCount":"5","resultStr":"{\"title\":\"Economic impact of self-administered subcutaneous versus clinic-administered intravenous immunoglobulin G therapy in Alberta, Canada: a population-based cohort study.\",\"authors\":\"Bruce Ritchie, Karen J B Martins, Dat T Tran, Heather Blain, Lawrence Richer, Scott W Klarenbach\",\"doi\":\"10.1186/s13223-022-00735-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Self-administered subcutaneous immunoglobulin G (SCIg) reduces nursing time and eliminates the need for treatment at ambulatory care clinics, as compared with clinic-based intravenously administered IgG (IVIg), and are therapeutically equivalent. Estimating the economic impact of self-administered SCIg versus clinic-administered IVIg therapy may guide treatment recommendations.</p><p><strong>Methods: </strong>A retrospective population-based cohort study using administrative data from Alberta was performed; those treated with IgG between April 1, 2012 and March 31, 2019 were included. Costs for medical laboratory staff and nursing time, as well as ambulatory care visits were considered. Univariate generalized linear model regression with gamma distribution and log link was used to compare cost ($CDN 2020) between SCIg and IVIg administration. Stratified analysis by age (≥ 18-years; < 18-years) was performed.</p><p><strong>Results: </strong>Among 7,890 (6,148 adults; 1,742 children) individuals who received IgG, the average administration cost per patient-year of self-administered SCIg was $5,386 (95% confidence interval [CI] $5,039, $5,734) lower than clinic-administered IVIg; per patient-year cost of self-administered SCIg was $817 (95% CI $723, $912) versus $6,204 (95% CI $6,100, $6,308) for clinic-administered IVIg. The per patient-year cost of self-administered SCIg was $5,931 (95% CI $5,543, $6,319) lower among adults and $3,177 (95% CI $2,473, $3,882) lower among children compared with clinic-administered IVIg. An estimated $31.0 million (95% CI $29.0, $33.0) in cost savings to the health system would be realised if 80% of individuals switched from clinic-administered IVIg to self-administered SCIg.</p><p><strong>Conclusions: </strong>Self-administered SCIg is substantially less costly from a health care payer perspective in Canada. 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引用次数: 5
摘要
背景:与以临床为基础的静脉注射IgG (IVIg)相比，自我皮下注射免疫球蛋白G (SCIg)减少了护理时间，消除了在门诊治疗的需要，并且治疗等效。评估自我给药SCIg与临床给药IVIg治疗的经济影响可以指导治疗建议。方法:采用艾伯塔省的行政数据进行回顾性人群队列研究;纳入2012年4月1日至2019年3月31日期间接受IgG治疗的患者。考虑了医疗实验室人员和护理时间以及门诊就诊的费用。采用伽马分布和对数链接的单变量广义线性模型回归比较SCIg和IVIg给药的成本($CDN 2020)。按年龄(≥18岁)分层分析结果:7890例(6148例成人;在接受IgG治疗的1,742名儿童中，自我给药SCIg的每患者年平均给药成本为5,386美元(95%可信区间[CI] 5,039美元，5,734美元)，低于临床给药IVIg;自我给药SCIg的每位患者年成本为817美元(95% CI为723美元，912美元)，而临床给药IVIg的每位患者年成本为6204美元(95% CI为6100美元，6308美元)。与临床给药IVIg相比，成人自我给药SCIg的每位患者年成本低5,931美元(95% CI $5,543, 6,319美元)，儿童患者年成本低3,177美元(95% CI $2,473, 3,882美元)。如果80%的个人从临床给药IVIg转向自我给药SCIg，估计可为卫生系统节省3100万美元(95% CI $ 290， $33.0)的成本。结论:从加拿大卫生保健支付者的角度来看，自我施用SCIg的成本大大降低。在这种类型的卫生系统中，转向自我管理的SCIg有可能降低总体卫生保健成本，减轻护理负担，并可能增加诊所为他人提供的能力。
Economic impact of self-administered subcutaneous versus clinic-administered intravenous immunoglobulin G therapy in Alberta, Canada: a population-based cohort study.
Background: Self-administered subcutaneous immunoglobulin G (SCIg) reduces nursing time and eliminates the need for treatment at ambulatory care clinics, as compared with clinic-based intravenously administered IgG (IVIg), and are therapeutically equivalent. Estimating the economic impact of self-administered SCIg versus clinic-administered IVIg therapy may guide treatment recommendations.
Methods: A retrospective population-based cohort study using administrative data from Alberta was performed; those treated with IgG between April 1, 2012 and March 31, 2019 were included. Costs for medical laboratory staff and nursing time, as well as ambulatory care visits were considered. Univariate generalized linear model regression with gamma distribution and log link was used to compare cost ($CDN 2020) between SCIg and IVIg administration. Stratified analysis by age (≥ 18-years; < 18-years) was performed.
Results: Among 7,890 (6,148 adults; 1,742 children) individuals who received IgG, the average administration cost per patient-year of self-administered SCIg was $5,386 (95% confidence interval [CI] $5,039, $5,734) lower than clinic-administered IVIg; per patient-year cost of self-administered SCIg was $817 (95% CI $723, $912) versus $6,204 (95% CI $6,100, $6,308) for clinic-administered IVIg. The per patient-year cost of self-administered SCIg was $5,931 (95% CI $5,543, $6,319) lower among adults and $3,177 (95% CI $2,473, $3,882) lower among children compared with clinic-administered IVIg. An estimated $31.0 million (95% CI $29.0, $33.0) in cost savings to the health system would be realised if 80% of individuals switched from clinic-administered IVIg to self-administered SCIg.
Conclusions: Self-administered SCIg is substantially less costly from a health care payer perspective in Canada. Within this type of health system, switching to self-administered SCIg has the potential to reduce overall health care costs, lessen nursing burden, and may increase clinic-based capacity for others.
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