Incorporating Treatment Into Life: A Retrospective Analysis of Clinical, Financial and Quality of Life Measures Following Hematopoietic Stem Cell Transplant in Patients Receiving Home Subcutaneous Immune Globulin

Hematopoietic stem cell transplant, (HSCT) is a treatment option for children with severe combined immune deficiency (SCID). Long term use of gamma globulin is sometimes necessary for patients who do not have complete B-cell recovery.  Recently, the use of subcutaneous immune globulin (SCIG) has become an increasingly popular alternative to IVIG.  The purpose of this poster is to retrospectively evaluate the clinical management and reported experiences of 11 patients with SCID who transitioned from hospital outpatient IVIG infusions to SCIG administered at home. 

The home infusion pharmacy and nursing evaluations of 11 post BMT patients, (ages 1-25, median age 4) were reviewed.  The patients received a total of 958 SCIG infusions for an average of 87 infusions per patient.  The clinical management model for these home SCIG patients included initial SCIG training from a home infusion RN.  In addition, ongoing pharmacist monitoring and management included:  identification and management of SCIG related side effects, weight, dose, compliance, reported infections, antibiotic use and labs.  The number of work or school days missed related to SCIG was assessed.

Most patients required three nursing visits before becoming independent with SCIG infusions.  11 infections were reported over 6246 patient days, or 0.0048 infections/patient/month.  15 days of school or work activities were missed, or 0.0026 missed days/patient/month.  18% of patients reported SCIG related side effects.  All were minor and managed at home.  This represented 0.34% of all infusions and is significantly lower than the reported 3% side effect rate of home IVIG. 

The average cost per patient for the initial SCIG training was $309.  The subsequent estimated average cost per patient for drug and supplies was $806 per month with a mean dose of 2.4 grams/week. The distance from the home to the outpatient infusion center ranged between 3 and 103 miles for an average travel time of 73 minutes each way, resulting in a travel time savings of 146 minutes per month when comparing home SCIG to outpatient IVIG.

Additional clinical assessment included quality of life interviews that queried the impact of outpatient IVIG vs SCIG at home on patient-reported issues (compliance, time, side effects, cost, health and preference). Results will be reported in detail.  Home SCIG enables incorporation of treatment into life, rather than working life into treatment for select clinically appropriate patients.  Nurses are in a unique position to empower and educate patients and caregivers on individualized options related to immune globulin site of service and route of administration.