INTRODUCTION

Plasma exchange (PLEX) is an effective treatment for antibody-mediated neurological disorders and has been shown to be equally efficacious to intravenous immunoglobulin (IVIg)¹. PLEX is often performed in an intensive care environment via membrane filtration which requires central venous access. However, PLEX can also be delivered with a centrifugation system via peripheral access, for example with the Spectra OptiaÒ apheresis system. We compared the economic cost of PLEX delivered by a neurology service for both outpatients and inpatients against the standard model of care with IVIg treatment.

METHOD

We prospectively collected data from all neurology patients receiving PLEX between May 2019 and May 2020. The cost of PLEX delivered in an outpatient setting for an average 80Kg person was calculated and compared to the equivalent cost of delivering IVIg.

RESULTS

A total of 44 patients received PLEX during this period, which included the first two months of the COVID-19 pandemic in the UK. 357 exchanges were performed over 12 months. A total of 247 (69.3%) of the exchanges were delivered in an outpatient setting at a cost of £348,630. The predicted equivalent cost for outpatients receiving IVIg as an alternative, is £541,522, based on an average commercial price. The annual cost saving for PLEX over IVIg is £192,892. In addition, delivering outpatient PLEX led to a redundancy of 247 inpatient hospital beds stays.

CONCLUSION

This prospective study of a novel outpatient neurology PLEX service, demonstrates that, delivered in this way, PLEX supersedes IVIg. It provides equal or better clinical outcomes¹, at a lower cost. An opportunity cost of underutilising PLEX should be considered by publicly funded healthcare systems. Further studies are underway to study the cost-effectiveness of PLEX in this cohort of patients.

References:

1. Osman C, Jennings R, El-Ghariani K, et al. Pract Neurol 2020, 20:92-99