OBJECTIVES: Laronidase, the current standard of care for attenuated MPS I patients, is an enzyme replacement therapy infused every week in a hospital or home setting. Home infusions only occur if the patient tolerates the infusion and could still be considered off-label in certain countries. There is little research assessing the differences in associated cost of infusions between the two settings.

METHODS: Patients with at least one encounter with laronidase from 2007-2015 were identified in the Truven dataset, a repository of insurance claims data in the United States. Infusions were regarded as separate events and were divided into home or hospital groups. Associated costs occurring on the day of the infusion were considered and codes with <5 encounters during the study period were discarded, as were 5 service dates with codes for both infusion settings deemed errors in coding. The unweighted average cost per infusion was calculated by dividing the total cost per code by the number of infusions and summing the codes. This methodology did not account for differences in patient and procedure counts per code. An F-test was then performed to test the variance between groups, and a two-sample one-tail t-test was used to determine if the cost of home infusion was lower than hospital.

RESULTS: The results show an average home infusion cost of $225.10, while hospital infusions were on average $586.50 per patient per infusion. This equates to an average savings of $361.40 per patient per infusion (p≤0.0001) when laronidase is administered in the home setting.

CONCLUSIONS: This is the first study to quantify the differences in associated costs between infusions of laronidase in the hospital versus home setting in the United States. The adjusted analysis demonstrates a statistically significant difference in cost of $361.40 per patient per infusion between home and hospital settings.