1 FEBRUARY
Correspondence Costs of Intravenous Immunoglobulin Therapy in Patients With Unconfirmed Parvovirus B19 Pure Red Cell Aplasia
488
•
CID 2015:60 (1 February)
•
CORRESPONDENCE
decrease prescription of IVIG outside the indication and help improve the efficiency of the healthcare system, as treatment costs are extremely high. Note Potential conflicts of interest. All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Luc Mouthon,1,2 Morgane Michel,3 Coralie Gandré,3,4,5 Catherine Montagnier-Petrissans,2 and Karine Chevreul3,4,5 1
Faculty of Medicine, Université Paris Descartes and Department of Internal Medicine, Cochin hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 2 Commission for the Adequate Prescription of Drugs, AP-HP, 3URC Eco Ile de France, AP-HP, 4Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, and 5 Inserm, ECEVE, U1123, Paris, France
References 1. Crabol Y, Terrier B, Rozenberg F, et al. Intravenous immunoglobulin therapy for pure red cell aplasia related to human parvovirus B19 infection: a retrospective study of 10 patients and review of the literature. Clin Infect Dis 2013; 56:968–77. 2. De Saint Pol T. L’obésité en France: les écarts entre catégories sociales s’accroissent. INSEE Prem 2007; 1123:1–4. 3. Assurance Maladie. Base des médicaments et informations tarifaires. Available at: http:// www.codage.ext.cnamts.fr/codif/bdm_it/index_ presentation.php?p_site=AMELI. Accessed 31 July 2014. Correspondence: Karine Chevreul, MD, PhD, URC Eco, Hôtel Dieu, 1 place du Parvis Notre-Dame, 75004 Paris, France ([email protected]). Clinical Infectious Diseases® 2015;60(3):488 © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. [email protected]. DOI: 10.1093/cid/ciu828
Downloaded from http://cid.oxfordjournals.org/ at Purdue University Libraries ADMN on June 14, 2015
TO THE EDITOR—In Crabol et al [1], the authors retrospectively reviewed all cases of intravenous immunoglobulin (IVIG) treatment for parvovirus B19 pure red cell aplasia (PRCA) in university hospitals of the Assistance Publique–Hôpitaux de Paris (AP-HP) between January 2000 and December 2005. After careful review, they found that only 10 of 36 patients who had been prescribed IVIG for parvovirus B19 PRCA truly met the diagnosis criteria for PRCA and had documented parvovirus B19 infection. Using those results, as well as the number of patients who had been prescribed IVIG for parvovirus B19 PRCA in AP-HP hospitals from 2006 to 2013, we looked at the costs of the estimated inappropriate prescription of IVIG in this indication between 2000 and 2013 in AP-HP hospitals, using the perspective of the French Statutory Health Insurance (SHI). We estimated the costs of drugs for the 10 patients with confirmed parvovirus B19 PRCA, deriving the dose received by each patient for each day of each course of treatment from Crabol et al [1] based on their sex and the French average weight for men and women [2], and computed drug costs using national SHI prices [3]. To extrapolate the results to the entire population that supposedly received IVIG for parvovirus B19 PRCA between 2000 and 2013, we assumed the same sex distribution (70% of women) and of patients not fulfilling the indication (72.2%) as in Crabol et al [1]. We then calculated the total loss for the SHI
of the inappropriate prescription of IVIG in this indication. No hospitalization cost was included, as patients were already hospitalized for their condition. A sensitivity analysis with decreased drug costs up to 20% was also conducted to take into account likely discounts obtained by hospitals from pharmaceutical companies, which also impacts the SHI’s reimbursement of hospitals (discounted price plus a 50% premium on the difference between official price and discounted price). The total loss for the SHI of IVIG prescribed to patients who did not have a confirmed parvovirus B19 PRCA (135 of 187), despite having it prescribed for that indication, amounted to €1 162 854 between 2000 and 2013 in AP-HP hospitals. The mean cost per patient over that period was €8614, and the mean annual loss for the SHI was €83 061. The sensitivity analysis found that discounts could lower the total loss to €930 283 (mean annual loss: €66 449). Despite limits in our estimation, in particular the use of average national weights and the lack of individual data for the population of interest, the costs incurred by the SHI from the prescription of IVIG to patients not fitting the indication are very high and represent >70% of the total costs of IVIG prescription in patients with suspected parvovirus B19 PRCA. This result led the Commission for the Adequate Prescription of Drugs of the AP-HP to ask physicians to check whether their patients fulfill all the criteria for that indication (anemia with reticulocyte count
Correspondence Costs of Intravenous Immunoglobulin Therapy in Patients With Unconfirmed Parvovirus B19 Pure Red Cell Aplasia
488
•
CID 2015:60 (1 February)
•
CORRESPONDENCE
decrease prescription of IVIG outside the indication and help improve the efficiency of the healthcare system, as treatment costs are extremely high. Note Potential conflicts of interest. All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Luc Mouthon,1,2 Morgane Michel,3 Coralie Gandré,3,4,5 Catherine Montagnier-Petrissans,2 and Karine Chevreul3,4,5 1
Faculty of Medicine, Université Paris Descartes and Department of Internal Medicine, Cochin hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 2 Commission for the Adequate Prescription of Drugs, AP-HP, 3URC Eco Ile de France, AP-HP, 4Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, and 5 Inserm, ECEVE, U1123, Paris, France
References 1. Crabol Y, Terrier B, Rozenberg F, et al. Intravenous immunoglobulin therapy for pure red cell aplasia related to human parvovirus B19 infection: a retrospective study of 10 patients and review of the literature. Clin Infect Dis 2013; 56:968–77. 2. De Saint Pol T. L’obésité en France: les écarts entre catégories sociales s’accroissent. INSEE Prem 2007; 1123:1–4. 3. Assurance Maladie. Base des médicaments et informations tarifaires. Available at: http:// www.codage.ext.cnamts.fr/codif/bdm_it/index_ presentation.php?p_site=AMELI. Accessed 31 July 2014. Correspondence: Karine Chevreul, MD, PhD, URC Eco, Hôtel Dieu, 1 place du Parvis Notre-Dame, 75004 Paris, France ([email protected]). Clinical Infectious Diseases® 2015;60(3):488 © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. [email protected]. DOI: 10.1093/cid/ciu828
Downloaded from http://cid.oxfordjournals.org/ at Purdue University Libraries ADMN on June 14, 2015
TO THE EDITOR—In Crabol et al [1], the authors retrospectively reviewed all cases of intravenous immunoglobulin (IVIG) treatment for parvovirus B19 pure red cell aplasia (PRCA) in university hospitals of the Assistance Publique–Hôpitaux de Paris (AP-HP) between January 2000 and December 2005. After careful review, they found that only 10 of 36 patients who had been prescribed IVIG for parvovirus B19 PRCA truly met the diagnosis criteria for PRCA and had documented parvovirus B19 infection. Using those results, as well as the number of patients who had been prescribed IVIG for parvovirus B19 PRCA in AP-HP hospitals from 2006 to 2013, we looked at the costs of the estimated inappropriate prescription of IVIG in this indication between 2000 and 2013 in AP-HP hospitals, using the perspective of the French Statutory Health Insurance (SHI). We estimated the costs of drugs for the 10 patients with confirmed parvovirus B19 PRCA, deriving the dose received by each patient for each day of each course of treatment from Crabol et al [1] based on their sex and the French average weight for men and women [2], and computed drug costs using national SHI prices [3]. To extrapolate the results to the entire population that supposedly received IVIG for parvovirus B19 PRCA between 2000 and 2013, we assumed the same sex distribution (70% of women) and of patients not fulfilling the indication (72.2%) as in Crabol et al [1]. We then calculated the total loss for the SHI
of the inappropriate prescription of IVIG in this indication. No hospitalization cost was included, as patients were already hospitalized for their condition. A sensitivity analysis with decreased drug costs up to 20% was also conducted to take into account likely discounts obtained by hospitals from pharmaceutical companies, which also impacts the SHI’s reimbursement of hospitals (discounted price plus a 50% premium on the difference between official price and discounted price). The total loss for the SHI of IVIG prescribed to patients who did not have a confirmed parvovirus B19 PRCA (135 of 187), despite having it prescribed for that indication, amounted to €1 162 854 between 2000 and 2013 in AP-HP hospitals. The mean cost per patient over that period was €8614, and the mean annual loss for the SHI was €83 061. The sensitivity analysis found that discounts could lower the total loss to €930 283 (mean annual loss: €66 449). Despite limits in our estimation, in particular the use of average national weights and the lack of individual data for the population of interest, the costs incurred by the SHI from the prescription of IVIG to patients not fitting the indication are very high and represent >70% of the total costs of IVIG prescription in patients with suspected parvovirus B19 PRCA. This result led the Commission for the Adequate Prescription of Drugs of the AP-HP to ask physicians to check whether their patients fulfill all the criteria for that indication (anemia with reticulocyte count
