Transcript Slide 1

SUBCUTANEOUS ADMINISTRATION OF GAMMANORM® IN IMMUNEDEFICIENT PATIENTS BY RAPID PUSH: REPORT OF THE BELGIAN
EXPERIENCE.
A. RENIERS, C. HEIJMANS, N. NOLS, R. ROMBAUT, R. PECHE (BELGIUM)
INGID PROGRAMME
SATURDAY, NOVEMBER 01, 2014
Disclosure of potential conflicts of interest
Home Nursing Reniers An bvba acts as a third party in a Patient Support
Program financed by Octapharma Benelux SA
Travel and accommodation costs for ESID 16th Biennial Meeting have been
covered by Octapharma Benelux SA (in the framework of the contractual
obligations of training between Octapharma and HNRA)
Subjects addressed
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Moving from IVIG at hospital to SCIG at home
Patient Support Program (PSP)
Rapid push versus pump(s)
Belgian patients’ cohort
Measuring patients’ satisfaction in the
framework of a PSP
 Case reports
 Key messages
Moving from IVIG at hospital to SCIG at home
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Reason for the treating physician: for the best interest of patients, lack of
place at the one-day clinic
Reasons for the patient: avoiding the hospital setting, tolerance, venous
access, less days out of school/work, distance to hospital…
Interest for health payers: lower costs
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Objective: to increase patients’ quality of life and satisfaction
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Moving patients from hospital- to home-therapy with self-infusion
 is a challenge for the patient and the health care staff
 Is a specific therapeutic circumstance where Patient Support Programs
can be useful
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Company-sponsored Patient Support Program (PSP)
Patient
Doctor
contacts
Nurse
Directs
3rd Party
Company
contract
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3 Octapharma-sponsored PSPs for gammanorm® in Belgium
Some hospitals have their own PSP
Objectives of PSP : the quality of care
– Proper use of drug
– Adherence to treatment
– Patients’ satisfaction
– Delegation of responsibility by treating physician without loss of control
– Logistics
Role of nurse in PSP for home infusion of IG
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Patients’ information on treatment modalities allowing an informed decision
by the patient in dialogue with the treating physician
 = Information session at home before decision on administration
modality
Initial training
 = First administration made by nurse at the hospital
Initiation of home treatment
 = Presence of the nurse for the first one to three home
administration(s)
Follow-up of treatment and report to treating physician
 = Visit at home preferably at the occasion of an administration
around every 3 months or at patient’s request
 Reporting adverse events, compliance, satisfaction and problems to
the treating physician
Logistics of products, material and disposables
Rapid push versus pump(s)
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Individual choice at a given time in a given situation
Duration and frequency of administrations
 Rapid push:
 normally 1ml/min
 20 ml twice a week = 40 min
 Same dose (40 ml/week) with pump takes around 100 min if two sites
of injection are used
Patient’s involvement
 Slightly more involved when rapid push
Costs
 Material
 Infusion with pump: 12.39 € per infusion (considering 1 pump and a
life span of 4 years of the pump)
 Rapid push: 1.22 €
 Total cost per gram in case of 10 ml (1.65 g) / injection and 40 €/g IG:
 Rapid push: 66.27 €/1.65 = 40.74 €/g
 Pump: 73.44 €/1.65 = 47.51 €/g
 Δ = + 16.62 %
The material and the technical complexity
Patients’ cohort
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32 patients in the HNRA PSP at the time of abstract submission
Not all patients were offered the choice between pump and rapid push by
their treating physician
22 patients currently on gammanorm® had this choice
All patients were previously treated at the hospital by IVIG
15 (12 adults and 3 children) are on rapid push, 7 (4 adults and 3 children)
on pump
Age: from 2 to 71
Duration of treatment: from several months to more than 3 years
10 to 60 ml per week
1 to 3 injections per week for rapid push; 1 injection per week by pump
Injections made by patients, mother, nurse or friend
Sites of injection: belly (90%), thigh, arm
Measuring patients’ satisfaction with treatment in the framework of a PSP
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Adherence to treatment is dependant of patients’ satisfaction with treatment
Measuring patients’ satisfaction with treatment was so an objective of the
PSP
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Life Quality Index (LQI) and SF-36 (CHQ-PF50 in patients < 14 years) have
been tried in a test series of 8 patients
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The SF36 is a well-known generic HRQoL instrument for adults (≥14 years)
consisting of 36 items forming nine sub-scales that has been regularly used
for evaluating HRQoL in PID patients under immunoglobulin treatment. In
our test series, SF36 scores appear however to be greatly influenced by
concomitant morbidities and not correlated to LQI scores.
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LQI is a patients’ satisfaction questionnaire initially developed for PID
patients under IVIG. It was here limited to three scales, namely “treatment
interference”, “treatment-related problems and “therapy setting”. From our
limited experience, LQI seems to be an interesting easy-to-use tool for an
objective evaluation of the satisfaction of PID patients receiving SCIG at
home.
LQI scores indicate a rather good satisfaction in the three scales
Case report: patient 011
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19 year old Male
On rapid push for more than 2 years
Self infusion in the belly 3 times a week (20 ml twice and 10 ml once)
50 minutes per week
Compliance not good
LQI: OK
Decision to move to pump in September 2014
Reason: 3x/week is too much, administrations at school (stays at the
boarding school) with its social impact
Now only home injections once a week
?: would this choice improved patient’s satisfaction
LQI will be measured after 6 months of pump administration
Conclusion:
 Besides LQI OK, understanding specific problems is important
 Home and school are different settings
Case report: patient 015
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60 year old Male
On rapid push for 16 months now after IV therapy at hospital
50 ml/week; 3 injections per week
Self administration in the belly
Concomitant disease and treatment: chemotherapy for gastric tumor
Initially lack of compliance due to the burden of chemotherapy
Strict follow-up by nurse and support and encouragement (phone calls,
visits, …)
Currently good compliance and LQI OK while SF36 reflecting concomitant
disease
Improvement of health status (no more infection episode)
Conclusion:
 Nurse’s intervention has greatly improved compliance leading to better
health status
Case report: patient 021
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2 year old Male
On rapid push for 11 months now after a first IV administration at hospital
10 ml once a week in 15 min
Injection made by mother in the tight with child in his chair playing with a
tablet
Concomitant disease: epilepsy
Previously, frequency of epilepsy crises increased because of repeated
fever episodes
According to mother: less infection episodes under rapid push and less
epilepsy crises and better (social) life for the whole family
Conclusion:
 Rapid push is a relatively easy procedure for young children
 A better control of infectious episodes has a positive impact on concomitant
disease and on the family environment
Remark:
 A 1.5 year old child has been recently put on rapid push
 6 ml once a week in 12 minutes
 Decision by the mother because of gain of time: how to maintain a 1.5 year
old child quiet during 45 minutes with pump?
Key messages
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Rapid push is a method of SCIG administration that is, to our opinion, to be
considered for home administration of IG in both adults and children
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Moving patients from hospital to home is an opportunity and a challenge
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PSP is an efficient tool for an optimal quality of care at home
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PSP specialized nurse plays a pivotal role in treatment adherence and
completion and proper use of drug
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Filling-in patient satisfaction questionnaire such as LQI once or twice a year
could be a way to evaluate objectively patients’ satisfaction with treatment.
This will be proposed to treating physicians in the framework of this PSP
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LQI is however, to our opinion, complementary to the more personal
(subjective) evaluation of satisfaction and problems by the PSP nurse
THANK YOU FOR YOUR ATTENTION
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