Optimising the Ivig Service: an Audit of Monitoring and Dosage

Background In NHNN, 388 patients received 203,571 g of IVIG (£35/g) during 2014/15 amounting to 3127 patient days (£250/person/day). The majority of the 91.7% on long-term treatment are neuromuscular patients. Aims In 2011 the Department of Health updated guidelines for monitoring and dosing of IVIg. This is an audit of a new, consultant-led IVIg monitoring service, run as a weekly outpatient clinic from July 2015. Methods We prospectively documented achievement of DOH recommendations on monitoring, patient outcome and any dosing changes. Comparison was made with the preceding year Results 90 neuromuscular IVIg patients (60% male) were referred. 58.9% CIDP, 35.6% MMN, 4% myositis, 2.5% other. Proportion assessed annually improved from 89.7% to 100%. Appropriate reporting to pharmacy/national IVIg database improved from 35% to 100%. Usage of established outcome measures improved from 2.5 to 3.4 per patient. A reduction of 472 g/month (4 treatment cessations) and 6 treatment days/month was achieved (£18, 020/month cost reduction) in the first 6 months. Mean (S.E.) interim improvement in RODS score=+2.2 (0.4); 10 m timed walk =+1.5 (2.1) and MRC sum score=+0.9 (1.1) indicating treatment responsiveness. Conclusion The new service has optimised compliance with national guidelines and facilitated safe, stable reduction in dose and treatment days.