Prophylactic Immune Globulin in Chronic Lymphocytic Leukemia

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Abstract
Cost-effectiveness studies have become important in our clinical decisions because of the rising cost of medical care. The increase in cost is due in part to a marked increase in the price of new pharmaceutical agents. However, the cost-effectiveness analysis of intravenous immune globulin in chronic lymphocytic leukemia performed by Weeks et al. on the basis of a randomized, double-blind clinical trial (July 11 issue)1 is misleading because the objective of the study was not to look for cost effectiveness but to prove clinical efficacy. The fact that broad criteria of eligibility for the study required either a ≤50 percent decrease from the lower limit of normal IgG levels or previous infections implies that a substantial number of patients would not have infections during the study. This information was not specified in the reports,1 , 2 but we infer from the average of 2.25 infections per patient in the control group and the total of 42 infections in 40 patients that approximately half the controls did not have any infections at all. Therefore, the use of a very expensive drug that requires several hours of infusions every three weeks for one year to prevent a complication that will occur in only half the subjects is obviously not going to be cost effective if the drug is given to everybody. The analysis comparing patients with IgG levels of ≥400 mg per deciliter with those with levels of 3 are included in the analysis.

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