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Economic evaluation of intravenous immune globulin therapy for Kawasaki syndrome
T P Klassen1, P C Rowe, A Gafni
1Department of Pediatrics, University of Ottawa, Ontario, Canada.
Insights
High-dose intravenous immune globulin (IVIG-HD) therapy for Kawasaki syndrome is more cost-effective and prevents more coronary artery dilation cases than aspirin alone or low-dose IVIG (IVIG-LD). This approach offers better clinical outcomes and economic benefits.
Area of Science:
- Pediatric infectious diseases
- Immunology
- Health economics
Background:
- Kawasaki syndrome is an acute febrile illness in children, primarily affecting the coronary arteries.
- Coronary artery abnormalities are a major concern, necessitating effective treatment strategies.
- Current treatment options include aspirin, low-dose intravenous immune globulin (IVIG-LD), and high-dose intravenous immune globulin (IVIG-HD).
Purpose of the Study:
- To compare the costs and clinical outcomes of three treatments for acute Kawasaki syndrome: aspirin, IVIG-LD, and IVIG-HD.
- To evaluate the economic and clinical effectiveness of different IVIG dosing strategies.
Main Methods:
- A cost-effectiveness model was developed, simulating 100 patients per treatment group.
- Costs were assessed using the Chedoke-McMaster Corporate Cost Model in 1992 Canadian dollars.
- Clinical outcomes, specifically coronary artery dilation prevalence at 7 weeks, were based on published literature.
Main Results:
- IVIG-HD therapy reduced costs by $323,400 per 100 patients and prevented 14 cases of coronary artery dilation compared to aspirin alone.
- IVIG-HD therapy reduced costs by $118,200 per 100 patients and prevented 2 cases of coronary artery aneurysm compared to IVIG-LD.
- Cost-effectiveness of IVIG-HD over IVIG-LD was sensitive to hospitalization duration.
Conclusions:
- High-dose intravenous immune globulin (IVIG-HD) is the preferred treatment for Kawasaki syndrome.
- IVIG-HD offers superior clinical outcomes by reducing coronary artery dilation rates.
- This treatment strategy is also associated with lower overall healthcare costs.
Objective:
To determine the costs and clinical outcomes of three alternative treatments of the acute phase of Kawasaki syndrome: aspirin alone; low doses of intravenously administered immune globulin (IVIG-LD), 400 mg/kg per dose for 4 days; and high doses of intravenously administered immune globulin (IVIG-HD), 2.0 gm/kg for one dose.
Design:
A model was developed that assumed the inclusion of 100 patients with acute Kawasaki syndrome in each treatment option. Costs were valued by using the Chedoke-McMaster Corporate Cost Model in 1992 Canadian dollars. Clinical outcome, based on the published literature, was measured by the prevalence of coronary artery dilation at 7 weeks from the diagnosis of Kawasaki syndrome.
Results:
For every 100 patients with Kawasaki syndrome, the cost was reduced by $323,400 when aspirin therapy alone was changed to IVIG-HD therapy and 14 cases of coronary artery dilation were thereby prevented. When IVIG-HD therapy was compared with IVIG-LD therapy, the cost was reduced by $118,200 because two cases of coronary artery aneurysm were prevented. This latter result was sensitive to the duration of hospitalization, with IVIG-HD costing $8500 more for every 100 patients than IVIG-LD when it was assumed that both groups were hospitalized for 5 days, an unlikely occurrence.
Conclusions:
Treatment with IVIG-HD for Kawasaki syndrome is preferred because it results in both lower costs and lower rates of coronary artery dilation.