OBJECTIVES:

Published literature that discusses the total cost of treatment by means of Intravenous Immunoglobulins (IVIG) versus Therapeutic Plasma Exchange (TPE) in Guillain-Barré Syndrome (GBS) and Myasthenia Gravis (MG) applies different cost drivers, making it difficult to compare studies. Simultaneously medical professionals as well as hospital administrators are – given the recent shortages of IVIG – considering comparing these 2 treatment options from a clinical benefit as well as from a cost point of view. This study intends to map the different cost drivers for both treatment options and to suggest how these could be incorporated in a single cost model.

METHODS:

A systematic literature review was performed on the drivers of cost for TPE and IVIG treatments in GBS and MG. Searches were performed on PubMed as well as through the ISPOR Scientific Presentations Database. 25 peer-reviewed publications were identified between 2000 and 2018. For each of those publication the main drivers of cost per treatment type were identified.

RESULTS:

The most frequently applied drivers of cost for a hospital treating GBS or MG patients by means of IVIG or TPE are: patient volume, total length of stay, treatment choice, time per treatment procedure, type of staff involved, cost of staff, patient days at the neurology ward, patient days at the intensive care unit, need for mechanical ventilation, adverse events of treatment, weight of the patient, drug price, central versus peripheral access line, diagnostic tests, capital equipment cost, disposable cost and severity of disease.

CONCLUSIONS:

A comprehensive cost model in GBS or MG to compare IVIG and TPE treatment, should consider costs that starts from the moment the patient is brought to the hospital (e.g. diagnostic test) until the patient leaves the hospital (e.g.ed cost) and that maps costs from multiple divisions within the hospital (e.g. pharmacy costs, staff costs, hospital department costs).