However, the small size of the populations compared and methodological insufficiencies have been underlined recently by Canadian authors [8]. IVIG costs, SCIG appears to be 25% less expensive with field data because of lower doses used in SCIG patients. The reality of the dose difference between both routes of administration needs to be confirmed by further and more specific studies. Keywords:economic evaluation, immunoglobulin replacement, subcutaneous, intravenous, main antibody deficiencies, home care == Introduction == Antibody deficiencies are the most frequent causes of primary immunodeficiency diseases (PID), accounting for approximately 6070% of all PID [1]. These deficiencies are a heterogeneous group of diseases which are usually classified into four main syndromes: agammaglobulinaemia, hyper-IgM syndromes (HIGM), hypogammaglobulinaemia including common variable immunodeficiency (CIVD) and selective immunoglobulin deficiencies [2,3]. These diseases share an increased susceptibility to potentially life-threatening infections, although the extent of this predisposition is usually variable, depending upon the depth of the deficiency. Lifelong immunoglobulin replacement therapy has been shown to be efficient and therefore has become the standard treatment for more than four decades [4]. Immunoglobulin replacement therapy can be administrated either by intravenous immunoglobulin infusions (IVIG) or by subcutaneous infusions (SCIG). Patients usually receive IVIG in an out-patient setting with an infusion every 21 or 28 days. In France, although possible, IVIG is seldom home-delivered. Conversely, SCIG is usually given at home in most cases with an infusion every 7 days. Because immunoglobulin replacement is usually a lifelong and expensive medication, it has to be assessed from an economic perspective. Whether one route of administration could be more efficient than another needs to be determined. Previous studies suggest that IVIG and SCIG offer comparative protection against infections and that adverse events are negligible [57]. However, the small size of the populations compared and methodological insufficiencies have been underlined recently by Canadian authors [8]. In terms of quality of life, there is evidence showing that patients with agammaglobulinaemia receiving immunoglobulin replacement have a quality of life close to the general populace [9]. Some results suggest that patients with home-based SCIG perceive an improved quality of life [10,11]. Regardless of the method of administration, costs are driven mainly by the cost of the Ig preparation that accounts for nearly 80% of total costs [8]. However, results of previous economic studies carried out in different countries (France, Germany and Sweden) have drawn diverse conclusions that may reflect the specificities of the local health systems [7,8,12,13]. Hitherto, only one study has been performed in France [12], and has not been considered to be an economic evaluation but merely a cost study by the Centre for Reviews and Dissemination of the University or college of York. This study aims to determine whether SCIG at home is usually cost-effective compared with IVIG delivery at hospital from a French interpersonal insurance perspective. The patient’s perspective was also considered, including assessment of out-of-pocket payments and satisfaction. == Methods == == Simulation == Based upon a systematic literature review, the assumption was made that both treatments provide identical clinical efficacy. If Ig replacement gives patients a normal quality of life, it can be assumed that quality adjusted life years (QALYS) of treated patients Vilazodone are close to 1. Hence, a cost minimization analysis was chosen. For out-patient treatment, hospital costs and costs of transportation were taken into account. For home care, cost of nurse care and cost of additional devices such as infusion pumps were also considered. The baseline case is usually a 50 kg young adult living 15 km from the hospital with a nurse 15 Rabbit polyclonal to PAX9 km Vilazodone from his home. The infusion dose for IVIG is usually 045 mg/kg every 21 days and 015 mg/kg every 7 days for SCIG. It is assumed that both methods of infusion require equal monthly doses. The cost Vilazodone of immunoglobulin is usually fixed by the French government bodies at 45/g for Vilazodone both treatments. In France, pumps are rented and French interpersonal insurance has fixed.