Intravenous Immunoglobulin (IVIG) in Treating Non-ventilated COVID-19 Patients with Moderate to Severe Hypoxia is Pharmacoeconomically Favorable When Appropriately Targeted

Poremba, M.; Dehner, M.; Perreiter, A.; Semma, A.; Mills, K.; Sakoulas, G.

Background: Prior studies have shown that intravenous immunoglobulin (IVIG) can improve outcomes in patients with COVID-19, but the high costs of IVIG leave questions as to its pharmacoeconomic value. Methods: The hospital costs of 2 IVIG vs. non-IVIG COVID-19 patient groups were compared. The first cohort was a case-control analysis of 10 non-ventilated moderately to severely hypoxic COVID-19 patients who received IVIG (Privigen) matched 1:2 with 20 control patients of similar age, body mass index (BMI), degree of hypoxemia, and co-morbidities. The second cohort consisted of patients enrolled in a previously published randomized open-label prospective study of 14 COVID-19 patients receiving standard of care (SOC) versus 13 patients who received SOC plus IVIG (Octagam 10%). Results: Among the first case control population, mean total direct costs including IVIG for the treatment group was $21,982 per IVIG-treated case versus $42,431 per case for matched non-IVIG receiving controls, representing a net cost reduction of $20,449 (48%) per case. For the second (randomized) group, mean total direct costs including IVIG for the treatment group was $28,268 per case versus $62,707 per case for untreated controls, representing a net cost reduction of $34,439 (55%) per case. 24% of the non-IVIG patients had hospital costs exceeded $80,000, as compared to none of the IVIG patient host (p=0.016, Fisher exact test). Conclusion: When allocated to the appropriate patient type (moderate to severe illness without end-organ comorbidities and age <70 years), IVIG can significantly reduce hospital costs in COVID-19 care. More importantly, it may reduce the demand on scare critical care resources during the COVID-19 pandemic.