Evaluating the Efficacy and Cost-Effectiveness of Plasmapheresis and Intravenous Immunoglobulin in Acute Guillain-Barre Syndrome Management in Emergency Departments

Waseem Ullah; Haider Ali; Yasir Muhammad; Naqeeb Ullah; Iqra Khalil; Sohail Ahmad; Obaid Ullah; Amjad Ali; Muhammad Younas Ali; Awais Manan; Sundas Safdar; Hanifullah Hanfi

doi:10.7759/cureus.72595

Evaluating the Efficacy and Cost-Effectiveness of Plasmapheresis and Intravenous Immunoglobulin in Acute Guillain-Barre Syndrome Management in Emergency Departments

Cureus. 2024 Oct 29;16(10):e72595. doi: 10.7759/cureus.72595. eCollection 2024 Oct.

Authors

Waseem Ullah¹, Haider Ali², Yasir Muhammad³, Naqeeb Ullah⁴, Iqra Khalil⁵, Sohail Ahmad⁴, Obaid Ullah⁶, Amjad Ali⁷, Muhammad Younas Ali⁸, Awais Manan⁹, Sundas Safdar¹⁰, Hanifullah Hanfi¹¹

Affiliations

¹ Acute Medicine, Russells Hall Hospital, Dudley, GBR.
² Internal Medicine (Specialty Group), Khyber Teaching Hospital, Peshawar, PAK.
³ General Medicine, Syed Medical Complex, Sialkot, PAK.
⁴ Internal Medicine, Lady Reading Hospital, Peshawar, PAK.
⁵ Medicine, Rehman Medical Institute, Peshawar, PAK.
⁶ Medicine, Sunderland Royal Hospital, Sunderland, GBR.
⁷ Internal Medicine, Rehman Medical Institute, Peshawar, PAK.
⁸ Medicine and Surgery, Gajju Khan Medical College, Nowshera, PAK.
⁹ General Physician, Bangash Clinic Doaba, Kohat, PAK.
¹⁰ Radiology, Hayatabad Medical Complex, Peshawar, PAK.
¹¹ Internal Medicine, Mardan Medical Complex, Mardan, PAK.

Abstract

Background: Guillain-Barre Syndrome (GBS) is a severe autoimmune neuropathy that has to be treated quickly and efficiently in emergency situations, when both cost and effectiveness are vital.

Objective: To compare the clinical outcomes and cost-effectiveness of plasmapheresis and intravenous immunoglobulin (IVIG) in managing acute GBS in emergency departments.

Methodology: A prospective observational study conducted from January to December 2023 evaluated the treatment of adults with acute GBS using IVIG or plasmapheresis. Cost analysis was done in conjunction with clinical outcomes assessment, such as improvement in motor function, length of recovery, and length of hospital stay. Each therapy group consisted of 39 individuals, and data were gathered via patient evaluations and medical records. Through statistical analysis, the two regimens' costs and results were compared.

Results: Plasmapheresis proved significantly more cost-effective than IVIG, with an average treatment cost of 295,000 Pakistani rupees (PKR) per patient versus 587,000 PKR for IVIG. Plasmapheresis showed a greater mean improvement in motor function (Glasgow Coma Scale (GCS) score change of 5.93 ± 2.17) compared to IVIG (4.98 ± 2.34), though the difference was not statistically significant (p=0.091). Recovery time was slightly shorter with plasmapheresis, averaging 8.26 ± 1.53 weeks versus 8.74 ± 1.87 weeks for IVIG (p=0.282). Hospital length of stay was marginally reduced with plasmapheresis (12.16 ± 3.28 days) compared to IVIG (12.95 ± 3.64 days, p=0.302). The time to reach maximum improvement was also shorter with plasmapheresis (6.51 ± 1.24 weeks) compared to IVIG (7.08 ± 1.32 weeks, p=0.260). Additionally, plasmapheresis had a lower complication rate, with 4 out of 39 patients (10.25%) experiencing complications, compared to 8 out of 39 patients (20.51%) with IVIG.

Conclusion: Plasmapheresis is more cost-effective than IVIG for acute GBS management in emergency departments, offering similar or potentially superior clinical outcomes at a lower cost.

Keywords: cost-effectiveness; emergency department; guillain-barre syndrome; intravenous immunoglobulin; plasmapheresis.