Selective high dose gamma-globulin treatment in Kawasaki disease: Assessment of clinical aspects and cost effectiveness

Noboru Sato, Tetsu Sugimura, Teiji Akagi, Rumi Yamakawa, Kanoko Hashino, Genju Eto, Motofumi Iemura, Masahiro Ishii, Hirohisa Kato

Research output: Contribution to journalArticle

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Abstract

Background: High-dose intravenous gamma-globulin (IVGG) plus aspirin (ASA) treatment is effective in preventing coronary artery complications in acute Kawasaki disease (KD). However gamma-globulin is very expensive, especially in Japan. Furthermore the indication for IVGG treatment and the optimal dose of gamma-globulin remain controversial. Objectives: To examine these two issues, we used Harada's scoring system to investigate whether a single 2 g/kg dose therapy has any advantage over the 5 day 400 mg/kg per day therapy. Methods: We studied 203 patients with KD who had no coronary artery complications on admission. Of these, 145 patients scored 4 or more on Harada score within the first 9 days of illness and were treated with IVGG treatment. Using a random number table, 72 patients were selected to receive a single 2 g/kg dose (2 g group), while the remaining 73 patients were treated with 400 mg/kg per day for 5 consecutive days (400 mg group). Those who had a Harada score of three or less received no IVGG (non-IVGG group) treatment (58 patients). Results: The incidence rate of coronary artery complications in the 2 g group was significantly lower than in the 400 mg group. The duration of high fever, positive duration of C-reactive protein and the number of hospital days in the 2 g group were each significantly shorter than in the 400 mg group. The total medical expense in the 2 g group was significantly lower than in the 400 mg group. There were no coronary artery complications in the non-IVGG group. Conclusions: It was found to be clinically more effective and more cost effective to select a patient by Harada's scoring system and, where a score of four or more was obtained, to administer a single 2 g/kg intravenous dose of gamma-globulin for acute KD.

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalPediatrics International
Volume41
Issue number1
DOIs
Publication statusPublished - 1999
Externally publishedYes

Fingerprint

Mucocutaneous Lymph Node Syndrome
gamma-Globulins
Cost-Benefit Analysis
Coronary Vessels
Therapeutics
Acute Disease
Sick Leave
C-Reactive Protein
Aspirin
Japan
Fever
Costs and Cost Analysis
Incidence

Keywords

  • Harada's score
  • Intravenous gamma-globulin treatment
  • Kawasaki disease
  • Medical cost
  • Optimal dose

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Selective high dose gamma-globulin treatment in Kawasaki disease : Assessment of clinical aspects and cost effectiveness. / Sato, Noboru; Sugimura, Tetsu; Akagi, Teiji; Yamakawa, Rumi; Hashino, Kanoko; Eto, Genju; Iemura, Motofumi; Ishii, Masahiro; Kato, Hirohisa.

In: Pediatrics International, Vol. 41, No. 1, 1999, p. 1-7.

Research output: Contribution to journalArticle

Sato, Noboru ; Sugimura, Tetsu ; Akagi, Teiji ; Yamakawa, Rumi ; Hashino, Kanoko ; Eto, Genju ; Iemura, Motofumi ; Ishii, Masahiro ; Kato, Hirohisa. / Selective high dose gamma-globulin treatment in Kawasaki disease : Assessment of clinical aspects and cost effectiveness. In: Pediatrics International. 1999 ; Vol. 41, No. 1. pp. 1-7.
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T1 - Selective high dose gamma-globulin treatment in Kawasaki disease

T2 - Assessment of clinical aspects and cost effectiveness

AU - Sato, Noboru

AU - Sugimura, Tetsu

AU - Akagi, Teiji

AU - Yamakawa, Rumi

AU - Hashino, Kanoko

AU - Eto, Genju

AU - Iemura, Motofumi

AU - Ishii, Masahiro

AU - Kato, Hirohisa

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AB - Background: High-dose intravenous gamma-globulin (IVGG) plus aspirin (ASA) treatment is effective in preventing coronary artery complications in acute Kawasaki disease (KD). However gamma-globulin is very expensive, especially in Japan. Furthermore the indication for IVGG treatment and the optimal dose of gamma-globulin remain controversial. Objectives: To examine these two issues, we used Harada's scoring system to investigate whether a single 2 g/kg dose therapy has any advantage over the 5 day 400 mg/kg per day therapy. Methods: We studied 203 patients with KD who had no coronary artery complications on admission. Of these, 145 patients scored 4 or more on Harada score within the first 9 days of illness and were treated with IVGG treatment. Using a random number table, 72 patients were selected to receive a single 2 g/kg dose (2 g group), while the remaining 73 patients were treated with 400 mg/kg per day for 5 consecutive days (400 mg group). Those who had a Harada score of three or less received no IVGG (non-IVGG group) treatment (58 patients). Results: The incidence rate of coronary artery complications in the 2 g group was significantly lower than in the 400 mg group. The duration of high fever, positive duration of C-reactive protein and the number of hospital days in the 2 g group were each significantly shorter than in the 400 mg group. The total medical expense in the 2 g group was significantly lower than in the 400 mg group. There were no coronary artery complications in the non-IVGG group. Conclusions: It was found to be clinically more effective and more cost effective to select a patient by Harada's scoring system and, where a score of four or more was obtained, to administer a single 2 g/kg intravenous dose of gamma-globulin for acute KD.

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KW - Medical cost

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