Differences in Infection Rates Between Outpatient Hospital, Clinic and Home Infusion Settings for Patients with Primary Immunodeficiency Disorder (PID)

Home-based infusion of IVIG therapy compared to the outpatient hospital (OH) or clinic setting may be beneficial for PIDD patients due to the potentially reduced risk of exposure to infections. This analysis compared infection rates among PIDD patients who infused in the home, clinic or OH. Patients who had at least 1 inpatient or ER claim or at least 2 outpatient claims with PIDD ICD-9 code 279.xx and had at least 6 months of continuous IVIG claims from the same site of care (home, clinic or OH) were identified from the Truven Marketscan Database, years 2002 -2012. Incidence rates of pneumonia and bronchitis were calculated for each site of care. Regression analyses were conducted to compare age and gender-adjusted infection rates between sites. 2758 patients infused in the clinic, 2006 in the home, and 1919 in the OH setting. Pneumonia rates were 0.67, 0.55 and 1.04 and chronic bronchitis rates were 0.38, 0.24, and 0.59 for the clinic, home and OH settings, respectively. After adjusting for age and gender, the rates of pneumonia and bronchitis not otherwise specified (NOS) in the OH setting were found to be significantly higher than in the home (p=0.008, p=0.0185, respectively). Rates of chronic bronchitis were found to be significantly higher in both clinic (p=0.0144) and OH (p<0.0001) compared to home. Differences in rates of pneumonia and bronchitis NOS between home and clinic were not significant. Home infusion is associated with significantly lower rates of pneumonia and bronchitis compared to the OH among PIDD patients.