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The Cost-Effectiveness of Plasmapheresis

 

In this section, we analyze the cost-effectiveness of plasmapheresis as a therapeutic option for three diseases: Goodpasture’s Syndrome, Systemic Lupus Erythematosus, and Guillain-Barré Syndrome. For each disease, the cost-effective analysis took a variety of factors into account, including treatment efficacy, quality of life, cost, and the availability of alternative therapies.

 

Goodpasture’s Syndrome:

 

Below: Lung pathology of Goodpasture's syndrome

 

Plasmapheresis is considered a Category I treatment for this disease, meaning that therapeutic plasmapheresis is a standard first-line therapy and efficacy of the treatment has been proven in clinical trials and published experience. There is no available alternative therapy, although plasmapheresis is usually combined with cyclophosphamide and corticosteroids. If the disease is treated early, most patients will recover kidney function. In this case, quality of life is very good, as patients who recover kidney function will most likely be able to live healthy, normal lives after the disease is cured. Considering the lack of alternatives and the quality of life of patients after the disease, plasmapheresis is very cost-effective. However, it is very rare for kidney function to recover if the disease is treated late (creatinine levels above 6.6 mg/dL). These patients will require either maintenance dialysis or a kidney transplant in order to survive after the disease is cured, and thus the cost-effectiveness of plasmapheresis is significantly diminished when Goodpasture’s syndrome is treated late. Nevertheless, it is important to note that when treatment is initiated as soon as symptoms being to appear, the use of plasmapheresis as a therapy for Goodpasture’s syndrome is extremely cost-effective and is one of the classic examples of effective plasmapheresis usage in medicine.

 

Systemic Lupus Erythematosus:

 

Above: symptoms of SLE

 

The original usage of plasmapheresis was based on the assumption that reducing the level of self-targeting antibodies would affect the progression of the disease. However, this has been proven untrue. Plasmapheresis is considered a Category III treatment for this disease, meaning that therapeutic plasmapheresis has not been proven to be effective, and that application of the treatment is usually a last-ditch effort to save a patient. Specifically in lupus nephritis (kidney involvement in SLE), plasmapheresis is considered a Category IV treatment, meaning that the treatment has been proven to be ineffective. Front-line treatment generally involves immunosuppression, and in the case of lupus nephritis, maintenance dialysis. Considering the conflicting data in the literature of the efficacy of plasmapheresis for SLE and the availability of a front-line treatment, plasmapheresis is not a cost-effective therapy for SLE.

 

Guillain-Barré Syndrome:

Plasmapheresis is considered a Category I treatment for this disease, meaning that therapeutic plasmapheresis is a standard first-line therapy and efficacy of the treatment has been proven in clinical trials and published experience. A newer treatment called intravenous immunoglobulin (IVIg) is also available as an alternative first-line therapy for the disease, and medical literature has shown that plasmapheresis and IVIg have equivalent efficacy in treating Guillain-Barré (it is important to note that plasmapheresis combined with IVIg has NOT been proven to be more effective than either treatment alone). The complications due to treatment with IVIg are comparable to those due to plasmapheresis in that almost all complications are mild and not life-threatening. Both plasmapheresis and IVIg result in very good quality of life when the treatments work, with a utility estimate of 0.73 for IVIg, compared to a utility estimate of 0.69 for plasmapheresis, as seen below (quality of life is measured from 0 to 1, with 0 being death and 1 representing optimal health).

 

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Jivraj F et al. Cost Utility Analysis of IVIg Versus Plasma Exchange for the Treatment of Guillain-Barré Syndrome. http://augmentium.com/pdfs/professional/GBS-Presentation.pdf

 

The costs of plasmapheresis and IVIg, however, are significantly different. The average cost per patient of IVIg treatment is $10,074.29, whereas the average cost per patient of plasmapheresis treatment is $6027.00 (see below).

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Nagpal S et al. Treatment of Guillain-Barré Syndrome: A Cost-Effectiveness Analysis. Journal of Clinical Apheresis 1999; 14.

This data shows that plasmapheresis is about $4000 cheaper than IVIg per patient for treatment of Guillain-Barré syndrome. Since both treatments are equally effective, equally safe, and equally improve quality of life, it makes sense to conclude that plasmapheresis is the most cost-effective therapy for Guillain-Barré syndrome. However, if plasmapheresis fails to improve patient condition, IVIg is a viable cost-effective alternative treatment.

 

Conclusion:

The cost-effectiveness of plasmapheresis as a therapy varies greatly from disease to disease. For some diseases, plasmapheresis is the only effective front-line treatment, and it significantly improves patient quality of life. For other diseases, plasmapheresis is only of limited utility and does not significantly improve patient quality of life. There may also be effective alternative therapies available to treat certain diseases. If you are a potential plasmapheresis patient, we strongly recommend that you talk with your doctor in order to determine what course of treatment would be best for you.

 

Sources:
Szczepiorkowski Z et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence-Based Approach from the Apheresis Applications Committee of the American Society for Apheresis. Journal of Clinical Apheresis 2007; 22.

Jivraj F et al. Cost Utility Analysis of IVIg Versus Plasma Exchange for the Treatment of Guillain-Barré Syndrome. http://augmentium.com/pdfs/professional/GBS-Presentation.pdf

Nagpal S et al. Treatment of Guillain-Barré Syndrome: A Cost-Effectiveness Analysis. Journal of Clinical Apheresis 1999; 14.

Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Randomised trial of plasma exchange, intravenous immunoglobulin, and combined treatments in Guillain-Barré syndrome. Lancet 1997; 349.

Image Sources:
http://www.hdcn.com/symp/lund/jtimg28.jpg

http://www.nlm.nih.gov/medlineplus/ency/imagepages/17134.htm