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Quality of Life and Health-Care Resource Utilization Among Children with Primary Immunodeficiency Receiving Home Treatment with Subcutaneous Human Immunoglobulin

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Abstract

Introduction

Among patients with antibody deficiency, patient-reported outcomes are important for choosing between equally effective treatment regimens.

Patients and Methods

Twelve children (1.7–17.1 years) with primary immunodeficiency were switched from hospital-based intravenous IgG treatment to home treatment with subcutaneous IgG. Quality of life (Child Health Questionnaire) and health-care resource utilization were assessed at baseline and after 3 and 6 months.

Results

From the parents’ perspective, significant improvements were seen after 6 months for mental health (median difference; 95% confidence interval, 15.0; 0.0, 22.5); change in health (1.0; 0.0, 2.0); and family activities (12.5; 2.1, 25.0). From the children’s’ perspective, significant improvements were seen for role/social limitations-emotional at 3 (22.2; 11.1, 33.3) and 6 months (22.2; 11.1, 66.7) and global health at 6 months (35.0; 15.0, 55.0). There were no significant improvements in other concepts. Subcutaneous IgG treatment significantly reduced absence days, days spent on hospital/physician visits, and health-care-related expenses.

Conclusion

Switching to home-based subcutaneous IgG treatment led to significant improvements in quality of life and substantial cost savings.

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References

  1. Ballow M. Primary immunodeficiency disorders: antibody deficiency. J Allergy Clin Immunol. 2002;109:581–91.

    Article  PubMed  CAS  Google Scholar 

  2. Bonilla FA, Bernstein IL, Khan DA, Ballas ZK, Chinen J, Frank MM, Kobrynski LJ, Levinson AI, Mazer B, Nelson RP Jr, Orange JS, Routes JM, Shearer WT, Sorensen RU, American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. Practice parameter for the diagnosis and management of primary immunodeficiency. Ann Allergy Asthma Immunol 2005;94(Suppl 1):S1–63. Erratum in: Ann Allergy Asthma Immunol 96:504.

    Article  PubMed  Google Scholar 

  3. Champi C. Primary immunodeficiency disorders in children: prompt diagnosis can lead to lifesaving treatment. J Pediatr Health Care. 2002;16:16–21.

    PubMed  Google Scholar 

  4. Björkander J, Nikoskelainen J, Leibl H, Lanbeck P, Wallvik J, Lumio JT, Braconier JH, Pavlova BG, Birthistle K, Engl W, Walter S, Ehrlich HJ. Prospective open-label study of pharmacokinetics, efficacy and safety of a new 10% liquid intravenous immunoglobulin in patients with hypo- or agammaglobulinemia. Vox Sang. 2006;90:286–93.

    Article  PubMed  CAS  Google Scholar 

  5. Church JA, Leibl H, Stein MR, Melamed IR, Rubinstein A, Schneider LC, Wasserman RL, Pavlova BG, Birthistle K, Mancini M, Fritsch S, Patrone L, Moore-Perry K, Ehrlich HJ, US-PID-IGIV 10% -Study Group 10. Efficacy, safety and tolerability of a new 10% liquid intravenous immune globulin [IGIV 10%] in patients with primary immunodeficiency. J Clin Immunol. 2006;26:388–95.

    Article  PubMed  CAS  Google Scholar 

  6. Chapel HM, Spickett GP, Ericson D, Engl W, Eibl MM, Björkander J. The comparison of the efficacy and safety of intravenous versus subcutaneous immunoglobulin replacement therapy. J Clin Immunol. 2000;20:94–100.

    Article  PubMed  CAS  Google Scholar 

  7. Gardulf A, Hammarström L, Smith CI. Home treatment of hypogammaglobulinaemia with subcutaneous gammaglobulin by rapid infusion. Lancet. 1991;338:162–6.

    Article  PubMed  CAS  Google Scholar 

  8. Gardulf A, Nicolay U, Asensio O, Bernatowska E, Böck A, Carvalho BC, Granert C, Haag S, Hernández D, Kiessling P, Kus J, Pons J, Niehues T, Schmidt S, Schulze I, Borte M. Rapid subcutaneous IgG replacement therapy is effective and safe in children and adults with primary immunodeficiencies—a prospective, multi-national study. J Clin Immunol. 2006;26:177–85.

    Article  PubMed  CAS  Google Scholar 

  9. Ochs HD, Gupta S, Kiessling P, Nicolay U, Berger M, Subcutaneous IgG Study Group. Safety and efficacy of self-administered subcutaneous immunoglobulin in patients with primary immunodeficiency diseases. J Clin Immunol. 2006;26:265–73.

    Article  PubMed  CAS  Google Scholar 

  10. Berger M. Subcutaneous immunoglobulin replacement in primary immunodeficiencies. Clin Immunol. 2004;112:1–7.

    Article  PubMed  CAS  Google Scholar 

  11. Waniewski J, Gardulf A, Hammarström L. Bioavailability of gamma-globulin after subcutaneous infusions in patients with common variable immunodeficiency. J Clin Immunol. 1994;14:90–7.

    Article  PubMed  CAS  Google Scholar 

  12. Gardulf A, Nicolay U, Math D, Asensio O, Bernatowska E, Böck A, Costa-Carvalho BT, Granert C, Haag S, Hernández D, Kiessling P, Kus J, Matamoros N, Niehues T, Schmidt S, Schulze I, Borte M. Children and adults with primary antibody deficiencies gain quality of life by subcutaneous IgG self-infusions at home. J Allergy Clin Immunol. 2004;114:936–42.

    Article  PubMed  CAS  Google Scholar 

  13. Nicolay U, Kiessling P, Berger M, Gupta S, Yel L, Roifman CM, Gardulf A, Eichmann F, Haag S, Massion C, Ochs HD. Health-related quality of life and treatment satisfaction in North American patients with primary immunedeficiency diseases receiving subcutaneous IgG self-infusions at home. J Clin Immunol. 2006;26:65–72.

    Article  PubMed  CAS  Google Scholar 

  14. Gardulf A, Björvell H, Andersen V, Björkander J, Ericson D, Frøland SS, Gustafson R, Hammarström L, Nyström T, Søeberg B, Smith CIE. Lifelong treatment with gammaglobulin for primary antibody deficiencies: the patients’ experiences of subcutaneous self-infusions and home therapy. J Adv Nurs. 1995;21:917–27.

    Article  PubMed  CAS  Google Scholar 

  15. Kittner JM, Grimbacher B, Wulff W, Jager B, Schmidt RE. Patients’ attitude to subcutaneous immunoglobulin substitution as home therapy. J Clin Immunol. 2006;26(4):400–5.

    Article  PubMed  CAS  Google Scholar 

  16. Gardulf A, Nicolay U. Replacement IgG therapy and self-therapy at home improve the health-related quality of life in patients with primary antibody deficiencies. Curr Opin Allergy Clin Immunol. 2006;6(6):434–42.

    Article  PubMed  Google Scholar 

  17. Gardulf A, Andersen V, Björkander J, Ericson D, Frøland SS, Gustafson R, Hammarström L, Jacobsen MB, Jonsson E, Möller G, et al. Subcutaneous immunoglobulin replacement in patients with primary antibody deficiencies: safety and costs. Lancet. 1995;345:365–9.

    Article  PubMed  CAS  Google Scholar 

  18. Hogy B, Keinecke HO, Borte M. Pharmacoeconomic evaluation of immunoglobulin treatment in patients with antibody deficiencies from the perspective of the German statutory health insurance. Eur J Health Econ. 2005;6:24–9.

    Article  PubMed  Google Scholar 

  19. Fasth A, Nyström J. Safety and efficacy of subcutaneous human immunoglobulin in children with primary immunodeficiency. Acta Paediatr. 2007;96(10):1474–8.

    Article  PubMed  Google Scholar 

  20. Andersson Gäre B, Ruperto N, Berg S, Hagelberg S, Jonsson NO, Magnusson B, Martinell J, Erling A, Landgraf JM, Paediatric Rheumatology International Trials Organisation. The Swedish version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). Clin Exp Rheumatol. 2001;19(4 Suppl 23):S146–150.

    PubMed  Google Scholar 

  21. Norrby U, Nordholm L, Fasth A. Reliability and validity of the Swedish version of child health questionnaire. Scand J Rheumatol. 2003;32(2):101–7.

    Article  PubMed  Google Scholar 

  22. Norrby U, Nordholm L, Andersson-Gare B, Fasth A. Health-related quality of life in children diagnosed with asthma, diabetes, juvenile chronic arthritis or short stature. Acta Paediatr. 2006;95(4):450–6.

    Article  PubMed  Google Scholar 

  23. Landgraf JM, Abetz L, Ware JE. The CHQ user’s manual, second printing. Boston, MA, USA: HealthAct; 1999.

    Google Scholar 

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Acknowledgments

The authors would like to thank Dr Helen Wiggett of Dianthus Medical Limited for preparing the first draft of the manuscript. The study was funded by a research grant from Baxter Healthcare.

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Authors and Affiliations

  1. Department of Paediatrics, University of Gothenburg, The Queen Silvia Children’s Hospital, SE-416 85, Gothenburg, Sweden

    Anders Fasth

  2. Department of Oncology and Immunology, The Queen Silvia Children’s Hospital, SE-416 85, Gothenburg, Sweden

    Jeanette Nyström

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  1. Anders Fasth
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  2. Jeanette Nyström
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Corresponding author

Correspondence to Anders Fasth.

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Fasth, A., Nyström, J. Quality of Life and Health-Care Resource Utilization Among Children with Primary Immunodeficiency Receiving Home Treatment with Subcutaneous Human Immunoglobulin. J Clin Immunol 28, 370–378 (2008). https://doi.org/10.1007/s10875-008-9180-9

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  • DOI: https://doi.org/10.1007/s10875-008-9180-9

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