Economic evaluation: immunoglobulin vs prophylactic antibiotics in hypogammaglobulinemia and hematological malignancies.

Autor:	Carrillo de Albornoz S; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.; Centre for Health Economics, Monash University, Melbourne, Australia., Higgins AM; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia., Petrie D; Centre for Health Economics, Monash University, Melbourne, Australia., Irving A; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.; Centre for Health Economics, Monash University, Melbourne, Australia., Fanning L; Centre for Health Economics, Monash University, Melbourne, Australia., Weinkove R; Te Rerenga Ora Wellington Blood & Cancer Centre, Te Whatu Ora Health New Zealand Capital, Coast & Hutt Valley, Wellington, New Zealand.; Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand.; Department of Pathology & Molecular Medicine, University of Otago Wellington, Wellington, New Zealand., Crispin P; Canberra Hospital, Canberra, Australia.; School of Medicine and Psychology, Australian National University, Canberra, Australia., Dendle C; Monash Infectious Diseases, Monash Health, Melbourne, Australia.; School of Clinical Sciences, Monash University, Melbourne, Australia., Gilbertson M; Department of Clinical Haematology, Monash Health, Melbourne, Australia., Johnston A; Royal Hobart Hospital, Hobart, Australia.; University of Tasmania, Hobart, Australia., Keegan A; PathWest Laboratory Medicine, King Edward Memorial Hospital, Perth, Australia., Pepperell D; Department of Haematology, Fiona Stanley Hospital, Perth, Australia., Pullon H; Department of Haematology, Waikato Hospital, Hamilton, New Zealand., Reynolds J; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.; Central Clinical School, Monash University, Melbourne, Australia., van Tonder T; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia., Trotman J; Concord Repatriation General Hospital, Sydney, Australia.; University of Sydney, Sydney, Australia., Waters N; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia., Wellard C; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia., Weston H; Sunshine Coast University Hospital, Sunshine Coast, Australia., Morrissey CO; Central Clinical School, Monash University, Melbourne, Australia.; Department of Infectious Diseases, Alfred Health, Melbourne, Australia., Wood EM; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia., McQuilten ZK; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.; Department of Clinical Haematology, Monash Health, Melbourne, Australia.
Jazyk:	angličtina
Zdroj:	Blood advances [Blood Adv] 2024 May 14; Vol. 8 (9), pp. 2259-2267.
DOI:	10.1182/bloodadvances.2023012047
Abstrakt:	Abstract: Patients with hematological malignancies are at high risk of developing hypogammaglobulinemia (HGG) and infections. Immunoglobulin (Ig) is one recommended option to prevent these infections, but it is expensive, and its cost-effectiveness compared with other prevention strategies remains unknown. We conducted a trial-based economic evaluation from the Australian health care system perspective to estimate the 12-month cost-effectiveness of prophylactic Ig vs prophylactic antibiotics in 63 adults with HGG and hematological malignancies participating in the RATIONAL feasibility trial. Two analyses were conducted: (1) cost-utility analysis to assess the incremental cost per quality-adjusted life year (QALY) gained; and (2) cost-effectiveness analysis to assess the incremental cost per serious infection prevented (grade ≥3) and per any infection (any grade) prevented. Over 12 months, the total cost per patient was significantly higher in the Ig group than in the antibiotic group (mean difference, AU$29 140; P < .001). Most patients received IVIg, which was the main cost driver; only 2 patients in the intervention arm received subcutaneous Ig. There were nonsignificant differences in health outcomes. Results showed Ig was more costly than antibiotics and associated with fewer QALYs. The incremental cost-effectiveness ratio of Ig vs antibiotics was AU$111 262 per serious infection prevented, but Ig was more costly and associated with more infections when all infections were included. On average and for this patient population, Ig prophylaxis may not be cost-effective compared with prophylactic antibiotics. Further research is needed to confirm these findings in a larger population and considering longer-term outcomes. The trial was registered at the Australian and New Zealand Clinical Trials Registry as #ACTRN12616001723471. (© 2024 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)
Databáze:	MEDLINE
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