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Evidence to Improve Care

Home-Based Subcutaneous Infusion of Immunoglobulin for Primary and Secondary Immunodeficiencies

Ontario Health Technology Advisory Committee Recommendation

  • The Ontario Health Technology Advisory Committee recommends that home-based subcutaneous infusion of immunoglobulin be publicly funded for treatment of patients with primary and secondary immunodeficiencies.

Read the full OHTAC Recommendation

Immunodeficiency is a condition in which the body’s natural defence system, the immune system, is unable to produce sufficient antibodies to fight infection and disease. The condition can be primary, where you are born with it, or secondary, where it’s acquired through infection or as a side effect of a medical treatment.

Standard therapy for primary and secondary immunodeficiency is done in a hospital and consists of receiving regular injections of antibodies, administered into the veins.

Some hospitals are also using a treatment called subcutaneous infusion of immunoglobulin, which involves injecting antibodies into the fatty part of the tissue under the skin. With some training, this treatment can be performed at home by patients or caregivers.

Health Quality Ontario conducted a health technology assessment on home-based subcutaneous infusion versus hospital-based intravenous infusion of immunoglobulin in pediatric and adult populations with primary and secondary immunodeficiencies.

Studies have found that both treatments are comparable in how effective they are; however, patients receiving the home-based treatment reported higher levels of satisfaction. The home-based treatment provides greater convenience and cost savings to patients because of not having to travel to the hospital.

There are also system savings from the home-based treatment, mostly through reduced nursing time. Results suggest that the savings to the health care system would be approximately $5 million over 5 years.

Home-Based Subcutaneous Infusion of Immunoglobulin for Primary and Secondary Immunodeficiencies: A Health Technology Assessment
November 2017

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The Ministry of Health and Long-Term Care has accepted this recommendation.

The Ministry of Health and Long-Term Care has provided the following response: The Ministry provides annual funding to Canadian Blood Services, which purchases sub-cutaneous immunoglobulin on behalf of Ontario hospitals. Canadian Blood Services’ procurement agreement ensures subcutaneous immunoglobulin is available to Ontario patients along with the ancillary products and patient training required for home-based treatment.

Health Technology Assessment at Health Quality Ontario

As part of our core function to promote health care supported by the best available evidence, we use established scientific methods to analyze the evidence for a wide range of health interventions, including diagnostic tests, medical devices, interventional and surgical procedures, health care programs and models of care. These analyses are informed by input from a range of individuals, including patients and clinical experts. The Ontario Health Technology Advisory Committee — a committee of the Health Quality Ontario board of directors — reviews the evidence and makes recommendations about whether health care interventions should be publicly funded or not. Draft recommendations are posted on the Health Quality Ontario website for feedback. Final recommendations are approved by our board of directors and then shared with the Ministry of Health and Long-Term Care. For more detailed information, visit our Evidence to Improve Care pages.


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