OBJECTIVES

To evaluate the treatment cost of therapeutic plasma exchange (TPE) and Intravenous Immunoglobulins (IVIg) for the rare diseases Myasthenia Gravis (MG), Guillain-Barré Syndrome (GBS) and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) in outpatient settings.

METHODS

As rare disease patients are scattered over entire countries and continents, large scale evaluations of treatment costs are perceived as difficult. Hence, we applied a retrospective cohort study design utilizing hospital discharge records. The study included patient records from 2013 – 2018 from the USA. In total the study covered 76,966 outpatient encounters.

RESULTS

Out of 76,966 outpatient encounters that were identified, GBS accounted for n = 2,106 (with 11.5% TPE; 88.5% IVIg), CIDP n = 48,423 (8% TPE; 92% IVIg), chronic MG: n = 22,197 (29.4% TPE, 70.6% IVIg) and acute MG n = 4240 (23.7% TPE; 76.3% IVIg). Most patients were treated with IVIg. However, in each of the evaluated indications, the treatment cost for TPE was significantly lower than for IVIg (p <0.01). The following average costs were identified: (1) GBS: TPE: $1,405; IVIg: $5,487 (2) CIDP: TPE: $2,132; IVIg: $5,962 (3) Chronic MG TPE: $1,521; IVIg: $ 5,939 and (4) Acute MG: TPE: $ 1,759; IVIg: $5, 948. Depending on the indication, savings up to 66% treatment cost are possible when TPE would be favored over IVIg.

CONCLUSIONS

Using large scale data coming from outpatient patients diagnosed with four selected neuromuscular conditions (GBS, CIDP, MG without and with acute exacerbation), therapy costs with TPE were found to be significantly lower when compared to IVIg therapy costs. Hospitals investing in therapeutic plasma exchange are likely to experience savings in their treatment costs.