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Clinical and economic outcomes of a "high-touch" clinical management program for intravenous immunoglobulin therapy

Authors Zhu J, Kirkham HS, Ayer G, Chen CC, Wade RL, Karkare SU, Robson CH, Orange JS

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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