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September 22/29, 2004

Intravenous Immunoglobulin and Quality of Life—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(12):1429-1430. doi:10.1001/jama.292.12.1429-b

In Reply: The effort of Dr Padua and colleagues to provide data on QOL assessments after administration of IVIG is commendable and the results quite informative. However, I had envisioned a more comprehensive approach that combines QOL with pharmacoeconomics to provide comparable data between IVIG and other equally effective therapies.1

Intravenous immunoglobulin is a very expensive drug that in some disorders such as CIDP is as effective as prednisone, which is quite inexpensive. Early in the treatment of these disorders, IVIG is more costly than prednisone. However, for patients treated with prednisone alone for more than 2 to 3 years, the irreversible steroid adverse effects (osteoporosis, cataracts, diabetes, hypertension, obesity, avascular necrosis of the hip), seemingly incomplete response, frequent physician visits, time lost from work, and QOL issues may make the true cost comparable with that of IVIG.1 Preliminary data on CIDP from a double-blind study comparing IVIG to steroids2 showed that, during the short 6-week study period, IVIG was substantially more costly than prednisone, but the scores on the EuroQoL instrument increased more in the IVIG group compared with the prednisone group. Whether in the long run the mean annual health care costs of such steroid-related adverse effects and apparent reduction in QOL will offset the cost difference between IVIG and prednisone needs to be determined with careful long-term cost-utility analyses.

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