Implications to payers of switch from hospital-based intravenous immunoglobulin to home-based subcutaneous immunoglobulin therapy in patients with primary and secondary immunodeficiencies in Canada

Allergy, Asthma & Clinical Immunology

William C Gerth²  Stephen D Betschel³  Arthur S Zbrozek¹ 

[1] CSL Behring, King of Prussia, Pennsylvania 19406, USA

[2] W. C. Gerth & Associates, LLC, 33 E End Avenue, Shrewsbury, New Jersey 07702, USA

[3] St. Michael's Hospital and the University of Toronto, Toronto, Ontario M5B 1 W8, Canada

关键词: Nurse time;    SID;    PID;    FTEs;    Full time equivalents;    Labor costs;    SCIg;    IVIg;   

Others  :  791799
DOI  :  10.1186/1710-1492-10-23

 received in 2014-01-20, accepted in 2014-04-21,  发布年份 2014

【 摘 要 】

Background

Switching primary/secondary immunodeficiency (PID/SID) patients from intravenous immunoglobulin (IVIg) to home-based subcutaneous immunoglobulin (SCIg) therapy reduces nurse time. A nurse shortage in Canada provides an important context to estimate the net economic benefit, the number of patients needed to switch to SCIg to recoup one full-time equivalent (FTE), and potential population-wide savings of reduced nurse time to a payer.

Methods

The net economic benefit was estimated by multiplying the hourly compensation for nurses in Canada by the hours required for each administration route. The number needed to switch to SCIg to gain one nurse FTE was estimated by dividing the work hours in a year by the average annual savings in nursing time in a PID population in Canada. The prevalence of treated PID/SID in Canada was calculated using provincial IgG audit data to extrapolate the potential population-wide savings of switching patients to SCIg therapy.

Findings

The net economic gain from switching one patient to home-based SCIg care would be C$2,603 (Canadian Dollars) in year 1 and C$2,948 each year thereafter. Switching 37 IVIg patients to SCIg would gain one nurse FTE. Switching 50% of the estimated 5,486 PID and SID patients in Canada receiving IVIg therapy to SCIg has the potential to save 223.3 nurse FTEs (C$23.2 million in labor costs).

Conclusions

A shift from IVIg to less labor-intensive SCIg has the potential to help alleviate nurse shortages and reduce overall health care costs in Canada. Health care professionals might consider advocating for home-based SCIg therapy for PID/SID patients when clinically appropriate.

【 授权许可】

   
2014 Gerth et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Murphy GT, Birch S, Alder R, MacKenzie A, Lethbridge L, Little L, Cook A: Tested solutions for eliminating Canada’s registered nurse shortage. Ottawa: Canadian Nurses Association; 2009. http://www.nursesunions.ca/sites/default/files/rn_shortage_report_e.pdf webcite
• [2]The nursing workforce: Canadian Federation of Nurses Unions backgrounder CFNU January 2013 http://www.nursesunions.ca/sites/default/files/2013.backgrounder.nursing_workforce.e.pdf webcite
• [3]Gormann N, Losota M, McCracken M, Zitikyte D: Quick facts: absenteeism and overtime (2013). Adapted from: Trends in own illness or disability-related absenteeism and overtime among publicly-employed registered nurses - summary of key facts. Ottawa: Report prepared by Informetrica Limited for Canadian Federation of Nurses Unions; 2009.
• [4]Shields M, Wilkins K: Findings from the 2005 National Survey of the Work and Health of Nurses. Ottawa: Statistics Canada. Health Canada; 2006.
• [5]Canadian Blood Services: Overall Ig Issues (IV + SC). http://www.blood.ca/centreapps/internet/uw_v502_mainengine.nsf/page/E_PlasmaProducts webcite
• [6]Selin S, Lewis C, Wadsworth L, Pi D: Trends in intravenous immune globulin utilization in British Columbia. American Association of Blood Banks (AABB) Annual Meeting; 2009. http://www.pbco.ca/images/UM/2009%20AABB%20IVIG%20Poster.pdf webcite
• [7]Abolhassani H, Sadaghiani MS, Aghamohammadi A, Ochs HD, Rezaei N: Home-based subcutaneous immunoglobulin versus hospital-based intravenous immunoglobulin in treatment of primary antibody deficiencies: systematic review and meta analysis. J Clin Immunol 2012, 32:1180-1192.
• [8]Nicolay U, Kiessling P, Berger M, Gupta S, Yel L, Roifman CM, Gardulf A, Eichmann F, Haag S, Massion C, Ochs HD: Health-related quality of life and treatment satisfaction in North American patients with primary immunodeficiency diseases receiving subcutaneous IgG self-infusions at home. J Clin Immunol 2006, 26(1):65-72.
• [9]Macdonnell M, Darzi A: A key to slower health spending growth worldwide will be unlocking innovation to reduce the labor-intensity of care. Health Affairs 2013, 32(4):653-660.
• [10]Ducruet T, Levasseur MC, Des Roches A, Kafal A, Dicaire R, Haddad E: Pharmacoeconomic advantage of subcutaneous versus intravenous immunoglobulin treatment in a Canadian pediatric center. J Allerg Clin Immunol 2013, 131(2):585-7.
• [11]Martin A, Lavoie L, Goetghebeur M, Schellenberg R: Economic benefits of subcutaneous rapid push versus intravenous immunoglobulin infusion therapy in adult patients with primary immune deficiency. Transfusion Medicine 2013, 23(1):55-60.
• [12]Health Employers Association of BC: For the record: nurses in BC. 2012. http://www.heabc.bc.ca/public/bargaining/2012/for%20the%20record/Nurses.pdf webcite
• [13]Nova Scotia Provincial Blood Coordinating Program: Atlantic IVIG and SCIG Utilization in FY 2011–12. 2012. http://novascotia.ca/dhw/nspbcp/docs/IVIG-SCIG-Utilization-Atlantic-Provinces-FY-2011-12.pdf webcite
• [14]Ontario Regional Blood Coordinating Network (ORBCoN): Intravenous immune globulin (IVIG) utilization audit - executive summary. 2009. http://transfusionontario.org/en/cmdownloads/categories/ivig/# webcite
• [15]Canadian Federation of Nurses Unions: Overview of key nursing contract provisions. 2012. http://www.nursesunions.ca/sites/default/files/contract_comparison_english.pdf webcite
• [16]Roberts RR, Frutos PW, Ciavarella GG, Gussow LM, Mensah EK, Kampe LM, Straus HE, Joseph G, Rydman RJ: Distribution of variable vs fixed costs of hospital care. JAMA 1999, 281:644-649.
• [17]Regional Blood Coordinating Network (ORBCoN): Ontario intravenous immune globulin (IVIG) 2012 audit report. 2013. http://transfusionontario.org/en/cmdownloads/categories/reports/ webcite
• [18]Canadian Institute for Health Information (CIHI): Health care cost drivers: the facts. spending and workforce. 2011. https://secure.cihi.ca/free_products/health_care_cost_drivers_the_facts_en.pdf webcite