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Capillary leak syndrome cost-effectiveness of therapy

Introduction

Overview

Overview

The treatment of SCLS requires a combination of medications, and prices range according to severity of symptoms presented in individual patients. Whereas medication such as Bevacizumab can be $66.60 per 10 mg for 2 weeks, others like infliximab used for a duration of 5 mg/kg every 8 weeks may cost $99,171.00. It is also important to note that medication such as Theophylline and Terbutaline may accrue increased costs due to the neccesity of increased monitoring.

Cost-effective therapy

Cost-effective therapy

Medications used can be divided based on classes, such as Endothelial signal transduction and Immune modulators. Prices vary for medications within every given class.

Treatment Mechanism of Action

Endothelial signal transduction

Bevacizumab
  • Bevacizumab costs in 2014 averaged around $9324 for a total duration of 8 weeks
  • The average price of the drug was $66.60 per 10 mg given at 5 mg given every 2 weeks[1]
Epoprostenol
  • Over a two 6-month period, epoprostenol was estimated to cost around $19,483.48. This did not include equipment use of $283.25 which brought the total cost near $19,766.73[2]
Theophylline + Terbutaline
  • Due to the risk of toxicity, Theophylline requires increased monitoring. Due to this, costs can average around $121.40 per patient per month[3]
  • After studying admission for 13 days and 16 days, Theophylline costs were estimated to be around $12,864.22[4]
  • Compared to other tocolytics, Terbutaline required increased monitoring due to a higher incidence of adverse events resulting in an average cost of $399.02. Comparatively, nifedipine had an average cost of $16.75[5]

Immune modulation

Corticosteroids
  • Corticosteroids are commonly utilized to reduce underlying inflammation and has been used for SCLS
  • Septic shock, one of the underlying causes SCLS, requires corticosteroids as part of the treatment regimen
  • Hydrocortisone use averaged around $1,254,078.00 per QALY[6] and a 90-day monetized benefit of $25,539 per patient[7]
Infliximab
  • Studies show that, compared to other immune modulators, infliximab was more cost-effective when given at 5 mg/kg every 8 weeks at $99,171.00. Comparatively, adalimumab given at 40 mg every other week totalled around $316,378 and vedolizumab given every 8 weeks averaged $301,969[8]
IVIG
  • Annual costs for IVIG in the USA during 2014 were on average $9,720 per infusion or $108,016 per patient[9]
  • Other recent studies showed IVIG to be more cost-effective, averaging a cost of $78,814. When compared to plasmapheresis, IVIG was found to be more cost-effective[10]
Plasmapheresis
  • For use in inflammatory conditions, plasmapheresis costs averaged $101,140 per patient[11]
References

References

  1. ↑ “Bevacizumab Wins Cost-Effectiveness Contest in First-Line Metastatic Colorectal Cancer”. Am Health Drug Benefits. 8 (Spec Issue): 10–2. 2015. PMC 4570073. PMID 26380601.
  2. ↑ Petros AJ, Turner SC, Nunn AJ (1995). “Cost implications of using inhaled nitric oxide compared with epoprostenol for pulmonary hypertension”. J Pharm Technol. 11 (4): 163–6. doi:10.1177/875512259501100409. PMID 10144080.
  3. ↑ Jubran A, Gross N, Ramsdell J, Simonian R, Schuttenhelm K, Sax M; et al. (1993). “Comparative cost-effectiveness analysis of theophylline and ipratropium bromide in chronic obstructive pulmonary disease. A three-center study”. Chest. 103 (3): 678–84. doi:10.1378/chest.103.3.678. PMID 8449051.
  4. ↑ Hamilton RA, Gordon T (1992). “Incidence and cost of hospital admissions secondary to drug interactions involving theophylline”. Ann Pharmacother. 26 (12): 1507–11. doi:10.1177/106002809202601202. PMID 1482803.
  5. ↑ Hayes E, Moroz L, Pizzi L, Baxter J (2007). “A cost decision analysis of 4 tocolytic drugs”. Am J Obstet Gynecol. 197 (4): 383.e1–6. doi:10.1016/j.ajog.2007.06.052. PMID 17904969.
  6. ↑ Thompson KJ, Taylor CB, Venkatesh B, Cohen J, Hammond NE, Jan S; et al. (2020). “The cost-effectiveness of adjunctive corticosteroids for patients with septic shock”. Crit Care Resusc. 22 (3): 191–199. PMID 32900325 Check |pmid= value (help).
  7. ↑ Oh M, Patanwala AE, Alkhatib N, Almutairi A, Abraham I, Erstad B (2020). “Cost Analysis of Adjunctive Hydrocortisone Therapy for Septic Shock: U.S. Payer Perspective”. Crit Care Med. 48 (10): e906–e911. doi:10.1097/CCM.0000000000004501. PMID 32701552 Check |pmid= value (help).
  8. ↑ Yokomizo L, Limketkai B, Park KT (2016). “Cost-effectiveness of adalimumab, infliximab or vedolizumab as first-line biological therapy in moderate-to-severe ulcerative colitis”. BMJ Open Gastroenterol. 3 (1): e000093. doi:10.1136/bmjgast-2016-000093. PMC 4860720. PMID 27195130.
  9. ↑ Burt RK, Tappenden P, Balabanov R, Han X, Quigley K, Snowden JA; et al. (2021). “The Cost Effectiveness of Immunoglobulin vs. Hematopoietic Stem Cell Transplantation for CIDP”. Front Neurol. 12: 645263. doi:10.3389/fneur.2021.645263. PMC 8019941 Check |pmc= value (help). PMID 33828522 Check |pmid= value (help).
  10. ↑ Heatwole C, Johnson N, Holloway R, Noyes K (2011). “Plasma exchange versus intravenous immunoglobulin for myasthenia gravis crisis: an acute hospital cost comparison study”. J Clin Neuromuscul Dis. 13 (2): 85–94. doi:10.1097/CND.0b013e31822c34dd. PMC 3291869. PMID 22361692.
  11. ↑ Heatwole C, Johnson N, Holloway R, Noyes K (2011). “Plasma exchange versus intravenous immunoglobulin for myasthenia gravis crisis: an acute hospital cost comparison study”. J Clin Neuromuscul Dis. 13 (2): 85–94. doi:10.1097/CND.0b013e31822c34dd. PMC 3291869. PMID 22361692.


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C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: M. Hassan, M.B.B.S