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VBCR - April 2015, Volume 4, No 2 - Value Propositions

Granulomatosis with polyangiitis (GPA) is a rare disease characterized most often by inflammation of the small blood vessels of the respiratory system, although the kidneys and other organs may also be affected. GPA is complex, and prompt diagnosis and treatment are necessary to avoid serious complications. Approximately 90% of patients with GPA respond to treatment with a combination of corticosteroids and cyclophosphamide (CYC). The use of CYC, however, is associated with several adverse effects, including leukopenia. Currently there is no standard recommendation for monitoring white blood cell count while patients with GPA are receiving CYC therapy.

Investigators at Cleveland Clinic’s Center for Vasculitis Care and Research conducted a study to compare the cost-effectiveness of weekly versus monthly complete blood count (CBC) monitoring for surveillance of leukopenia. To evaluate weekly monitoring, the researchers used the GPA database of patients treated at Cleveland Clinic between 1992 and 2004. For the monthly arm, data from published studies were used.

Weekly CBC monitoring yielded 0.22 quality-adjusted life-years gained, a measure that reflects both the quantity and quality of life lived, and incurred $489 less in cost per patient compared with monthly monitoring. The researchers concluded that weekly CBC monitoring is cost-effective for prevention of severe leukopenia and infections in patients receiving daily CYC for severe GPA. Khasnis A. Consult QD website. March 4, 2015.

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Last modified: May 21, 2015
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