Clinical and economic outcomes of a "high-touch" clinical management program for intravenous immunoglobulin therapy
Received 26 May 2017
Accepted for publication 4 September 2017
Published 19 December 2017 Volume 2018:10 Pages 1—12
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Akshita Wason
Peer reviewer comments 3
Editor who approved publication: Professor Giorgio Lorenzo Colombo
Julia Zhu,1 Heather S Kirkham,1 Gretchen Ayer,2 Chi-Chang Chen,3 Rolin L Wade,3 Swapna U Karkare,4 Chester H Robson,1 Jordan S Orange5
1Walgreens, Deerfield, 2Option Care, Bannockburn, IL, 3Quintiles IMS, Plymouth Meeting, PA, 4Quintiles IMS, Deerfield, IL, 5Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
Objective: To compare clinical and economic outcomes of patients who received intravenous immunoglobulin (IVIG) therapies and were managed by a clinical management program vs the outcomes of matched controls using administrative claim data.
Methods: This retrospective cohort study used the PharMetrics Plus™ claim database between September 1, 2011 and June 30, 2014. Patients in the intervention group were from a “high-touch” IVIG clinical management program administered by a home infusion specialty pharmacy. A greedy propensity score matching algorithm was used to identify a control group from non-program patients. Generalized estimating equation models were employed to evaluate differences between cohorts who were followed for 1 year.
Results: Clinical outcomes were measured as infections and infusion-related adverse events. The proportion of patients who had serious bacterial infections was significantly lower (4.13% vs 7.75%, P=0.049) in the intervention group (n=242) compared to the control group (n=968). Other clinical outcomes assessed were not different between cohorts (P>0.050). The economic outcomes were measured as healthcare costs. The annual adjusted mean total health care costs of patients in the program were $26,522 lower compared to matched controls, representing a 20% lower cost ($109,476 vs $135,998, P=0.002). A major contribution to this difference ($17,269) was IVIG-related total outpatient cost (intervention vs control groups: $64,080 vs $81,349, P=0.001).
Conclusion: The patients in this high-touch IVIG clinical management program appeared to have comparable infections or adverse event rates and significantly lower total health costs compared to their matched controls.
Keywords: immunoglobulin, intravenous, management program, clinical outcomes, economic outcomes
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