PMID- 33828522
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231102
IS  - 1664-2295 (Print)
IS  - 1664-2295 (Electronic)
IS  - 1664-2295 (Linking)
VI  - 12
DP  - 2021
TI  - The Cost Effectiveness of Immunoglobulin vs. Hematopoietic Stem Cell 
      Transplantation for CIDP.
PG  - 645263
LID - 10.3389/fneur.2021.645263 [doi]
LID - 645263
AB  - Background: Intravenous immunoglobulin (IVIG) is effective as standard first line 
      therapy for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), but 
      some patients remain dependent on its long-term use. Recently, we have reported 
      that autologous non-myeloablative hematopoietic stem cell transplantation (HSCT) 
      is an effective second line therapy for CIDP. Objectives: To compare the cost of 
      chronic IVIG vs. autologous HSCT (a one-time therapy), we collected data on 
      patients with CIDP undergoing HSCT between 2017 and 2019. This was compared with 
      published literature on the costs and efficacy defined by the Inflammatory 
      Neuropathy Cause And Treatment (INCAT) disability score, Medical Research Council 
      (MRC) sum score, hand grip strength, and SF-36 quality of life (QOL) for CIDP. 
      Methods: Between 2017 and 2019, nineteen patients with chronic CIDP (mean disease 
      treatment duration prior to HSCT of 6 years) underwent autologous HSCT with mean 
      cost of $108,577 per patient (range $56,327-277,119, standard deviation $53,092). 
      After HSCT, 80% of patients remain IVIG and immune treatment free for up to 5 
      years. In comparison, published cost of IVIG treatment in the USA for an average 
      CIDP patient exceeds $136,000 per year. Despite remaining treatment free, HSCT 
      demonstrated greater improvement in efficacy compared to immunoglobulins. 
      Recommendations: Given the long-term treatment-free remission and better outcome 
      measurements, autologous HSCT is more cost effective than long-term IVIG 
      treatment in patients with chronic CIDP. However, costs will depend on patient 
      selection, the HSCT regimen, and regional variations. Further analysis of the 
      health economics, i.e., cost/outcome ratio, of HSCT as therapy for chronically 
      IVIG dependent CIDP is warranted.
CI  - Copyright (c) 2021 Burt, Tappenden, Balabanov, Han, Quigley, Snowden and Sharrack.
FAU - Burt, Richard K
AU  - Burt RK
AD  - Division of Immunotherapy, Department of Medicine, Northwestern University 
      Feinberg School of Medicine, Chicago, IL, United States.
FAU - Tappenden, Paul
AU  - Tappenden P
AD  - Health Economics and Decision Science, School of Health and Related Research, 
      University of Sheffield, Sheffield, United Kingdom.
FAU - Balabanov, Roumen
AU  - Balabanov R
AD  - Department of Neurology, Northwestern University Feinberg School of Medicine, 
      Chicago, IL, United States.
FAU - Han, Xiaoqiang
AU  - Han X
AD  - Division of Immunotherapy, Department of Medicine, Northwestern University 
      Feinberg School of Medicine, Chicago, IL, United States.
FAU - Quigley, Kathleen
AU  - Quigley K
AD  - Division of Immunotherapy, Department of Medicine, Northwestern University 
      Feinberg School of Medicine, Chicago, IL, United States.
FAU - Snowden, John A
AU  - Snowden JA
AD  - Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, 
      University of Sheffield, Sheffield, United Kingdom.
FAU - Sharrack, Basil
AU  - Sharrack B
AD  - Academic Department of Neuroscience and Sheffield, NIHR Translational 
      Neuroscience BRC, Sheffield Teaching Hospitals NHS Foundation Trust, University 
      of Sheffield, Sheffield, United Kingdom.
LA  - eng
PT  - Journal Article
DEP - 20210322
PL  - Switzerland
TA  - Front Neurol
JT  - Frontiers in neurology
JID - 101546899
PMC - PMC8019941
OTO - NOTNLM
OT  - CIDP
OT  - cost
OT  - health economics
OT  - hematopoietic stem cell transplantation
OT  - immunoglobulin
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2021/04/09 06:00
MHDA- 2021/04/09 06:01
PMCR- 2021/03/22
CRDT- 2021/04/08 06:26
PHST- 2021/01/14 00:00 [received]
PHST- 2021/02/22 00:00 [accepted]
PHST- 2021/04/08 06:26 [entrez]
PHST- 2021/04/09 06:00 [pubmed]
PHST- 2021/04/09 06:01 [medline]
PHST- 2021/03/22 00:00 [pmc-release]
AID - 10.3389/fneur.2021.645263 [doi]
PST - epublish
SO  - Front Neurol. 2021 Mar 22;12:645263. doi: 10.3389/fneur.2021.645263. eCollection 
      2021.