Cost-utility analysis of intravenous immunoglobulin and prednisolone for chronic inflammatory demyelinating polyradiculoneuropathy

Paul McCrone, Daniel Chisholm, Martin Knapp, Richard Hughes, Giancarlo Comi, Marinos C. Dalakas, Isabel Illa, Costas Kilindireas, Eduardo Nobile-Orazio, Anthony Swan, Peter Den Van Bergh, Hugh J. Willison

Research output: Contribution to journalArticle

Abstract

The aim of this study was to provide an incremental cost-effectiveness analysis comparing intravenous immunoglobulin (IVIg) and prednisolone treatment for chronic inflammatory demyelinating polyradiculoneuropathy. Patients were recruited to a double-blind randomized crossover trial from nine European centres and received either prednisolone or IVIg during the first 6-week treatment period on which the economic evaluation was based. A societal perspective was adopted in measuring service use and costs, although the costs of lost employment were not included. The main outcome measure in the economic evaluation was the number of quality adjusted life years (QALYs) gained, with change in a 11-point disability scale used to measure clinical outcomes. Service use and quality of life data were available for 25 patients. Baseline costs were controlled for using a bootstrapped multiple regression model. The cost difference between the two treatments was estimated to be €3754 over the 6-week period. Health-related quality of life, as measured by the EuroQol EQ-5D instrument, increased more in the IVIg group but the difference was not statistically significant. Using a net-benefit approach it was shown that the probability of IVIg being cost-effective in comparison with prednisolone was 0. 5 or above (i.e. was more likely to be cost-effective than cost-ineffective) only if one QALY was valued at over €250 000. The cost-effectiveness of IVIg is greatly affected by the price of IVIg and the amount administered. The impact of later side-effects of prednisolone on long-term costs and quality of life are likely to reduce the cost per QALY of IVIg treatment.

Original languageEnglish
Pages (from-to)687-694
Number of pages8
JournalEuropean Journal of Neurology
Volume10
Issue number6
DOIs
Publication statusPublished - Nov 2003

Keywords

  • CIDP
  • Cost-effectiveness analysis
  • Economic evaluation
  • IVIg
  • Peripheral nerve disorders
  • Prednisolone
  • QALYs

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

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    McCrone, P., Chisholm, D., Knapp, M., Hughes, R., Comi, G., Dalakas, M. C., Illa, I., Kilindireas, C., Nobile-Orazio, E., Swan, A., Van Bergh, P. D., & Willison, H. J. (2003). Cost-utility analysis of intravenous immunoglobulin and prednisolone for chronic inflammatory demyelinating polyradiculoneuropathy. European Journal of Neurology, 10(6), 687-694. https://doi.org/10.1046/j.1351-5101.2003.00701.x