Abstract
Introduction: Immunoglobulin G (IgG) replacement therapy is indicated for the treatment of adults and children with primary immunodeficiency and other medical conditions. IgG can be administered intravenously (IVIg) or subcutaneously (SCIg). The subcutaneous route also offers two infusion methods: pump infusion (PI) and rapid push (RP). Objective: To evaluate the financial impact through cost-minimization analysis of IVIg versus SCIg, including the PI and RP methods, in a health insurance provider with over 500,000 beneficiaries in Curitiba, Paraná. Methodology: This retrospective, descriptive study conducted a cost-minimization analysis among beneficiaries who received IgG from January 1, 2018, to May 31, 2019 (17 months), using secondary data extracted from the insurer's computerized system. It evaluated potential permutations between drug formulations (Flebogamma®, Endobolin kiovig®, Hyqvia®, Hizentra®, and Gammanorn®), routes of administration (IV and SC), and subcutaneous infusion methods (PI and RP) to describe hypothetical cost savings from substitution. Exclusion criteria included incorrect payments for technology, non-payment, justified deductions, and IgG volumes exceeding 50 mL. After exclusions, individual and total IgG expenses were calculated based on drug costs per presentation. Direct and indirect costs of materials, services, and facilities involved in care were incorporated into the calculation. Economic analyses were performed using Excel® software, version 2007. Results: On average annually, the insurer paid for 43,545,882 mg of Flebogamma®, 28,860,000 mg of Endobolin kiovig® 10%, 63,529 mg of Hyqvia®, and 1,411 mg of Hizentra®. No releases were excluded based on the aforementioned criteria. The economic analysis identified a direct cost of R$ 23,944,671.30, excluding infusion fees, services, and hospitalization costs. When hypothetically switching to Gammanorn®, which had the lowest cost per mg (R$/mg), cost reductions (both direct and indirect) were up to R$ 8,677,812.40 compared to Flebogamma®, R$ 4,684,382.29 (PI) for Endobolin kiovig®, and R$ 8,502.77 (PI) for Hyqvia®. Hizentra® was used only once during the analyzed period and therefore was not considered in the cost-minimization analysis. Considering only indirect costs such as room fees and medication planning and administration fees, savings ranged from R$ 134,032.64 to R$ 454,610.24, depending on the permutation between administration routes and methods (RP or PI). Conclusion: Economic analysis of IgG therapy demonstrates its relevance in optimizing the use of costly therapies, ensuring the sustainability of the healthcare system. Subcutaneous IgG, whether administered via pump infusion or RP method, presents a cost-minimizing option compared to the standard IV treatment in the supplementary healthcare context.
