IVGG has been used as an alternative to splenectomy (SPL) in children < 14 years with ITP for > 6 months (J Peds 10/83). Decision analysis was used to compare the benefits and costs of IVGG vs. SPL in the initial management of chronic ITP. Published reports and a survey of 11 pediatric hematology centers provided data for the analysis. For IVGG, the experience of the first 25 patients treated at Cornell was used: (1) THERAPY/COSTS: induction IVGG dose of 73 grams/pt (2 gms/kg) at $40/gm=$3,000, avg maintenance IVGG dose in a subsequent 6 month period of 117 gms/pt $5,000, office visits & CBC's=$780. (2) OUTCOME/MANAGEMENT: 5 remissions, 6 stable without IVGG, 4 infrequent (<q2months) maintenance IVGG, 5 frequent maintenance IVGG, 5 refractory (with subsequent response to SPL not impaired). 60% pts remission, partial response: $1,000 for IVGG past 12 months, 40% pts failing IVGG get SPL. For SPLENECTOMY: (1) COSTS: Surgery=$7000, admissions (two) for high fever=$3,000, office visit and CBC's $220 (2) OUTCOME/MANAGEMENT: 80% remission/partial response, pts failing SPL get IVGG for 6 months ($8,780). The base case comparison yields costs of $12,868 for IVGG and $11,976 for SPL, nearly equal costs for the two strategies. The major determinant variables were the initial cost of surgery and the maintenance costs of continuing IVGG. As the cost of IVGG is a function of weight, the benefit cost ratio shifts in favor of IVGG for younger children for whom SPL is less desirable in any event.
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Bussel, J., Ferry, J., Fifer, K. et al. 892 INTRAVENOUS GAMMAGLOBULIN VERSUS SPLENECTOMY IN CHRONIC ITP: AN ANALYSIS OF BENEFITS AND COSTS. Pediatr Res 19, 259 (1985). https://doi.org/10.1203/00006450-198504000-00922
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