Cost analysis of plasma-exchange therapy for the treatment of Guillain-Barre syndrome

Objective: To undertake a cost analysis of therapeutic strategies with plas ma exchange (PE) for the treatment of patients with Guillain-Barre syndrome . Design: A randomized clinical trial including 556 patients with Guillain-Ba rre syndrome. We demonstrated that in the group with mild disease (walking possible) two PEs were more effective than none in shortening the time to b eginning motor recovery. In the groups with moderate disease (walking impos sible) and or severe disease (mechanically ventilated patients) four sessio ns were more effective than two and no more effective than six in shortenin g the time to recovery of walking with assistance and for the recovery rate of full muscle strength within 1 year. Data on outcomes and costs was coll ected. Complete cost data were available on 546 from the 556 patients of th e trial. Costs were estimated from the viewpoint of the healthcare system a nd computed over a 1-year period. Because the analysis of medical outcomes did not show any difference regarding mortality but only on intermediate sh ort-term and long-term outcomes, we carried out a cost minimization analysi s. Results: In two groups a dominant strategy appeared, with greater efficacy and lower costs in the two-PE arm for the mild group: 21,353 euros vs. 38,7 53 euros and in the four-PE arm in the moderate group: 59,480 cures vs. 80, 737 euros, In the severe group four PEs were as efficient and somewhat less expensive than six: 57,621 vs, 61,056 euros, Conclusion: The treatment of Guillain-Barre syndrome by PE at the onset of disease appears to have medical justification, The least expensive strategi es are either more or equally efficient as more expensive strategies.