OBJECTIVES: Intravenous immunoglobulin (IVIG) is a known effective treatment to reduce the incidence of coronary artery aneurysms in children with Kawasaki Disease (KD). However, there are IVIG-resistant patients and a lack of clinical trial data to determine the best second round treatment. Using recent effectiveness findings from the KIDCARE study, this research aimed to determine if second round IVIG or infliximab is cost effective in KD patients with persistent or recrudescent fever.

METHODS: A decision tree was developed to estimate total costs and outcomes. Cost effectiveness ratios were calculated for both treatment pathways. Cost and resource use were estimated from MarketScan®, US Bureau Labor and Statistics, Redbook and relevant peer-reviewed sources. Outcomes were measured using fever-free days based on KIDCARE study results.

RESULTS: Use of infliximab 10 mg/kg in IVIG-resistant patients was found to be the least costly and more effective treatment pathway in children with KD. Infliximab saved one additional fever-free day at a cost of $33,529. The second IVIG treatment pathway had a cost of $1,809 per additional fever-free day and the infliximab treatment pathway had a cost of $1,289 per additional fever-free day. This indicates that infliximab treatment of IVIG-resistant children with KD is dominant.

CONCLUSIONS: Infliximab is the economically preferred treatment choice for IVIG-resistant patients with KD compared to a second dose of IVIG under a range of assumptions.