BACKGROUND AND OBJECTIVES: In 10% to 20% of cases, Kawasaki disease is refractory to intravenous immunoglobulin (IVIg), an expensive medication under a national shortage. Data suggest that infliximab is a viable alternative to a second dose of IVIg, with similar efficacy and safety. We compared the cost of a second IVIg dose to that of infliximab in the treatment of refractory Kawasaki disease (rKD). METHODS: A decision analysis model was used to compare rKD treatments: a second dose of IVIg at 2 g/kg versus infliximab at 10 mg/kg. Infliximab monitoring times were 24, 36, and 48 hours. Direct hospital costs beginning at rKD diagnosis were estimated by using 2016-2017 Truven MarketScan data. Redbook was used for drug costs. Calculations were applied to 3 hypothetical cohorts of 100 patients aged 2 (12.5 kg), 4 (16 kg), and 8 years (25.5 kg). Indirect costs included parental missed workdays. RESULTS: The total direct cost for children receiving IVIg was $1 677 801, $1 791 652, and $2 100 675 for the 2-, 4-, and 8-year-old cohorts. The direct cost of infliximab with 24 hours of monitoring was $853 042, $899 096, and $1 024 101, respectively. A 20% bidirectional sensitivity analysis revealed stability of our model, with overall cost savings with use of infliximab. With monitoring 48 hours after infliximab treatment, 20% changes in length of stay (LOS) tipped the balance for the 2- and 4-year-old cohorts. Overall, IVIg and infliximab LOS had the most influence on our model. CONCLUSIONS: Infliximab has potential to yield shorter LOS and significant cost savings in the treatment of rKD. Infliximab treatment, followed by 24 hours of monitoring, nearly halved hospital costs, regardless of age.
BACKGROUND AND OBJECTIVES: In 10% to 20% of cases, Kawasaki disease is refractory to intravenous immunoglobulin (IVIg), an expensive medication under a national shortage. Data suggest that infliximab is a viable alternative to a second dose of IVIg, with similar efficacy and safety. We compared the cost of a second IVIg dose to that of infliximab in the treatment of refractory Kawasaki disease (rKD). METHODS: A decision analysis model was used to compare rKD treatments: a second dose of IVIg at 2 g/kg versus infliximab at 10 mg/kg. Infliximab monitoring times were 24, 36, and 48 hours. Direct hospital costs beginning at rKD diagnosis were estimated by using 2016-2017 Truven MarketScan data. Redbook was used for drug costs. Calculations were applied to 3 hypothetical cohorts of 100 patients aged 2 (12.5 kg), 4 (16 kg), and 8 years (25.5 kg). Indirect costs included parental missed workdays. RESULTS: The total direct cost for children receiving IVIg was $1 677 801, $1 791 652, and $2 100 675 for the 2-, 4-, and 8-year-old cohorts. The direct cost of infliximab with 24 hours of monitoring was $853 042, $899 096, and $1 024 101, respectively. A 20% bidirectional sensitivity analysis revealed stability of our model, with overall cost savings with use of infliximab. With monitoring 48 hours after infliximab treatment, 20% changes in length of stay (LOS) tipped the balance for the 2- and 4-year-old cohorts. Overall, IVIg and infliximab LOS had the most influence on our model. CONCLUSIONS: Infliximab has potential to yield shorter LOS and significant cost savings in the treatment of rKD. Infliximab treatment, followed by 24 hours of monitoring, nearly halved hospital costs, regardless of age.
Authors: Jane C Burns; Brookie M Best; Asuncion Mejias; Lynn Mahony; David E Fixler; Hasan S Jafri; Marian E Melish; Mary Anne Jackson; Basim I Asmar; David J Lang; James D Connor; Edmund V Capparelli; Monica L Keen; Khalid Mamun; Gregory F Keenan; Octavio Ramilo Journal: J Pediatr Date: 2008-07-30 Impact factor: 4.406
Authors: Melanie D Whittington; R Brett McQueen; Daniel A Ollendorf; Jeffrey A Tice; Richard H Chapman; Steven D Pearson; Jonathan D Campbell Journal: Ann Allergy Asthma Immunol Date: 2016-12-04 Impact factor: 6.347
Authors: Samantha C Roberts; Sonia Jain; Adriana H Tremoulet; Katherine K Kim; Jane C Burns; Vikram Anand; Marsha Anderson; Jocelyn Ang; Emily Ansusinha; Moshe Arditi; Negar Ashouri; Allison Bartlett; Archana Chatterjee; Roberta DeBiasi; Cornelia Dekker; Chandani DeZure; Lisa Didion; Samuel Dominguez; Rana El Feghaly; Guliz Erdem; Natasha Halasa; Ashraf Harahsheh; Mary Anne Jackson; Preeti Jaggi; Supriya Jain; Pei-Ni Jone; Neeru Kaushik; Gregory Kurio; Anna Lillian; David Lloyd; John Manaloor; Amy McNelis; David E Michalik; Jane Newburger; Charles Newcomer; Tiffany Perkins; Michael Portman; Jose Romero; Tova Ronis; Anne Rowley; Kathryn Schneider; Jennifer Schuster; S Kristen Sexson Tejtel; Kavita Sharma; Kari Simonsen; Jacqueline Szmuszkovicz; Dongngan Truong; James Wood; Sylvia Yeh Journal: Contemp Clin Trials Date: 2019-03-03 Impact factor: 2.226
Authors: Mary Beth Son; Kimberlee Gauvreau; Jane C Burns; Elena Corinaldesi; Adriana H Tremoulet; Virginia E Watson; Annette Baker; David R Fulton; Robert P Sundel; Jane W Newburger Journal: J Pediatr Date: 2010-12-03 Impact factor: 4.406
Authors: Brian W McCrindle; Anne H Rowley; Jane W Newburger; Jane C Burns; Anne F Bolger; Michael Gewitz; Annette L Baker; Mary Anne Jackson; Masato Takahashi; Pinak B Shah; Tohru Kobayashi; Mei-Hwan Wu; Tsutomu T Saji; Elfriede Pahl Journal: Circulation Date: 2017-03-29 Impact factor: 29.690
Authors: Adriana H Tremoulet; Sonia Jain; Preeti Jaggi; Susan Jimenez-Fernandez; Joan M Pancheri; Xiaoying Sun; John T Kanegaye; John P Kovalchin; Beth F Printz; Octavio Ramilo; Jane C Burns Journal: Lancet Date: 2014-02-24 Impact factor: 79.321