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Published Online, 1 November 2005, www.theannals.com, DOI 10.1345/aph.1E595.
 The Annals of Pharmacotherapy: Vol. 39, No. 12, pp. 2003-2008. DOI 10.1345/aph.1E595
© 2005 Harvey Whitney Books Company.
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PHARMACOECONOMICS

Cost of Intravenous Immunoglobulin Therapy Versus Conventional Immunosuppressive Therapy in Patients with Mucous Membrane Pemphigoid: A Preliminary Study

Yassine Daoud, MD1, Ketan G Amin, DMD2, Krishn Mohan, MD3, and A Razzaque Ahmed, MD4

1 Research Fellow, Department of Ophthalmology, Harvard Medical School, Boston, MA
2 Research Fellow, Department of Periodontology, Harvard School of Dental Medicine
3 Research Fellow, Center for Blistering Diseases, New England Baptist Hospital, Boston
4 Director, Center for Blistering Diseases, New England Baptist Hospital

Reprints: Dr. Ahmed, Center for Blistering Diseases, 70 Parker Hill Ave., Boston, MA 02120-3224, fax 617/754-6434, arahmedmd{at}msn.com

BACKGROUND: Intravenous immunoglobulin (IVIG) is an expensive biologic agent used to treat patients with mucous membrane pemphigoid (MMP) nonresponsive to conventional immunosuppressive therapy (CIST). The high cost of IVIG is of concern to healthcare providers and insurance companies.

OBJECTIVE: To compare the cost of IVIG with that of CIST in treating a cohort of 15 patients with severe and extensive MMP.

METHODS: Fifteen patients with biopsy-proven MMP nonresponsive to CIST were subsequently treated with IVIG and demonstrated a positive clinical response. This was a comparative, retrospective study; the mean total duration of the observation period was 8.4 years. A comparison of the cost of IVIG with that of CIST during the study period and the annual cost was performed. The cost of CIST was defined as the actual cost of the drug plus the cost of management of the multiple adverse effects, including hospitalizations, produced by CIST. In the same patient cohort, no significant adverse effects to IVIG were observed and no hospitalizations were required. Hence, the cost of IVIG therapy is simply the actual cost of the IVIG.

RESULTS: In this cohort of patients, CIST had significant adverse effects, many of which were hazardous and required prolonged and frequent hospitalizations. The mean total cost using IVIG therapy was significantly less than that of CIST during the entire course of the disease (p < 0.001) and on an annual basis (p < 0.05).

CONCLUSIONS: IVIG therapy is a safe, clinically beneficial, and less-expensive alternative treatment in patients with progressive MMP that is nonresponsive to CIST.

Key Words: mucous membrane pemphigoid: conventional immunosuppressive therapy, intravenous immunoglobulin therapy, cost comparison

Published Online, November 1, 2005. www.theannals.com, DOI 10.1345/aph.1E595




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