Efficacy and Cost Effectiveness of Therapeutic Plasma Exchange in patient of Guillain-Barre Syndrome – A Prospective study

Abstract

Introduction: Guillain-Barre syndrome (GBS) is an acute, frequently severe, fulminant poly-radiculoneuropathy that is autoimmune in nature. Current treatment modalities include therapeutic plasma exchange (TPE) and high dose intravenous Immunoglobulin therapy (I.V Ig), both of which involve a high cost. Objectives: To compare the cost effectiveness of plasma exchange over other modalities and to evaluate the clinical benefits of plasma exchange GBS patients. Discussion: In the present study, 100 patients (56 males and 44 females) admitted to the Civil Hospital, Ahmedabad from September 2010 to August 2012 with clinical findings of GBS and/or GBS variants were evaluated. Plasma was exchanged using a Baxter-CS 3000 continuous flow cell separator using double lumen femoral catheter, until a plasma discard of 50ml/kg had been achieved. Cost of treatment with plasma exchange for each patient was compared with other available modalities. Incidence of GBS was found to be more in 11-30 years age group. Male to female ratio was 1.27: 1. Most of the patients underwent 3 cycles of exchange. The result of plasma exchange in terms of improvement in clinical condition of patient was Excellent i.e. more than 85% in 82 patients. No complication was seen in 62 patients and minor complications were observed in 21 patients. The cost of plasma exchange and immunoglobulin treatment were came out to be approximately Rs 30,000/- and Rs. 1, 74,000/- in each patient respectively. Conclusion: Plasma exchange proved to be a better and less costly in the treatment of GBS patient if performed in the first two weeks of onset.