A potential 40% cost savings through treating cidp with tpe instead of ivig

Objectives CIDP is an inflammatory neuropathy with a prevalence of ~3/100 000. In most countries, CIDP is first treated with IVIg; long term maintenance therapy is usually necessary and the recommended dose is 1 gm/kg every 3 weeks. Therapeutic plasma exchange (TPE) is equally effective to IVIg in a number of diseases. A typical TPE maintenance schedule is 2 days every 3 weeks. TPE and IVIg in NZ are provided by the NZ Blood Service to district health boards (DHB’s); the cost is standardised throughout the country. Our objective was to determine which treatment was more cost-effective for DHB’s. Methods NZBS provided the cost of IVIg and TPE in NZ to the DHBs, including replacement fluids, based on 2016 charges. We assumed a IVIg maintenance schedule of 1 gm/kg every 3 weeks or 2 TPE procedures every 3 weeks. Results Using reported prevalence, there are ~140 patients with CIDP in NZ. The cost to DHB’s per year would have been NZ$119 680 per patient or NZ$16.76 million if all patients had been treated with IVIg for the entire year. The cost of treating those patients with TPE would have been NZ$68 564 per patient or NZ$9.6 million. Conclusions TPE is cheaper than IVIg for CIDP with respect to what is paid by DHB’s to the NZBS. It is unknown if similar cost savings exist in other healthcare systems. Potentially, IVIg may not need to be continued at full doses for an entire year and similarly TPE may not need to be continued at the same frequency. To address issues such as convenience of therapy and total patient care costs a prospective evaluation is needed. Furthermore, as there are no head-to-head IVIG-to-TPE studies in CIDP, the long-term efficacy of TPE in treating CIDP requires evaluation.