Treatment of Guillain-Barre Syndrome: A cost-effectiveness analysis

Acute Guillain-Barre syndrome is the most common cause of neuromuscular par alysis. Plasma exchange and intravenous immune globulin (IV IgG) are both e ffective treatments for this condition and the purpose of this report was t o compare the cost-effectiveness of these two modalities. A MEDLINE search was performed to identify randomized studies that compared the use of TV Ig G and plasma exchange for treatment of acute Guillain-Barre syndrome to det ermine if one modality was more effective and/or safer for the management o f this condition. A decision analysis was structured around the alternative s facing neurologists who must choose a treatment regimen for patients diag nosed with acute Guillain-Barre syndrome who require active therapy. Cost i nformation was obtained directly from product manufacturers and hospital so urces. Two head-to-head trials comparing the effectiveness of plasma exchan ge and IV IgG for treatment of acute Guillain-Barre syndrome determined tha t there was insufficient evidence to suggest one therapy was more effective than the other; therefore, a cost minimization analysis was performed. The costs per patient of plasma exchange and TV IgG for the treatment of acute Guillain-Barre syndrome were $6,204 and $10,165, respectively. A sensitivi ty analysis determined the model was sensitive to the cost of IV IgG. The c ost savings per patient treatment for the use of plasma exchange varied fro m $304 to $6,625 depending on the IV IgG product selected. Plasma exchange and IV IgG are both effective treatments for Guillain-Barre syndrome. Howev er, our analysis determined plasma exchange on average was almost $4,000 le ss costly per patient than IV IgG. Further research is required to determin e the impact of patient and physician preferences on the treatment of this disorder. (C) 1999 Wiley-Liss,Inc.