Cost-minimization analysis of the direct costs of TPE and IVIg in the treatment of Guillain-Barré syndrome

Table 1 Direct hospital costs of a five-treatment inpatient course of intravenous immunoglobulin (IVIg)

Resource	Cost *
IVIg, 0.4 g/kg (70 kg patient) × 5 infusions @ $70.22/g^a	$9,830.80
Direct RN labor cost (73 min × $0.79/min)^b cost × 5 infusions	$474.00
IVIg infusion supplies × 5 infusions^c	$25.05
TOTAL COST	$10,325.05

^a IVIg hospital cost $70.22 shown above is based on hospital contracted prices paid to manufacturers. Starting in Q1-2011 Medicare OPPS (outpatient prospective payment system) IVIg reimbursement is $73.30/gram based on average of five IVIg brands. Medicare payment rates for Q1-2011 are based on 106% of third quarter 2010 manufacturer's reported average sales price, which serves as a proxy for hospital acquisition cost, distributor mark-up and direct overhead including storage, preparation and disposal costs).
^b Center for Medicare and Medicaid Services (CMS). CY 2010 Labor file. RUC source for CPT 96365 and 96366. Assumes an average two-hour infusion (one unit each of CPT 96365 + CPT 96366), which utilizes 59 minutes and 14 minutes (total 73 minutes) of nurse clinical labor time. This value understates typical labor costs for a PE nurse operator, which is better approximated by the RUC value of $0.79/minute applied for therapeutic intravenous infusions; we used that higher labor rate in our cost model.
^c CMS. CY 2010 Supplies file. RUC source for CPT 96365 and 96366.

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