Background

• Intravenous immune globulins (IVIGs) represent an enormous spend of over $1.7 billion annually for U.S. health systems.
• There are nine major brands with over 100 off-label uses, despite FDA approval for fewer than ten indications.

Health System 1: “Do we really need multiple brands?”

Challenge
Massive IVIG spending forced a health system in the Northwest to question whether using seven different brands made clinical and financial sense.

Solution
Lumere reviewed over 200 published studies to compare safety and efficacy across brands. The evidence showed that six brands had similarly broad utility across patient populations. Standardizing to one of the six would provide similar patient outcomes while cutting costs.

Impact
Standardizing 80% of IVIG volume to one brand will yield a projected $480,000 in annual savings.

Health System 2: “How can we curb off-label use?”

Challenge
A West Coast academic medical center (AMC) needed to implement use restrictions to combat rampant off-label utilization.

Solution
Lumere’s review of the evidence showed that, of the AMC’s top ten uses for IVIG, only five were supported by evidence, four were conditionally supported and one was not supported.

Impact
Service line working groups used Lumere’s guidance on appropriate utilization and dosing to create and implement rigorous policies to standardize care and reduce off-label use.