A systematic review of strategies to encourage judicious use of scarce resources, such as immunoglobulin

Immunoglobulin (Ig) has potential benefits across many clinical indications but is costly – Ig use in Australia, excluding administrative costs, costs ~$745 million per annum. As highlighted by recent Medical Services Advisory Committee (MSAC) assessments, the current evidence base is insufficient to make informed decisions about for whom and for how long Ig use is cost-effective. This lack of evidence makes treatment decisions difficult and has the potential to lead to over- and under- use of Ig and inequitable access across patients. Understanding the factors that influence consumer preferences for Ig use and outcomes is critical for economic modelling and necessary to design strategies that encourage optimal use. This systematic review is intended to summarise the evidence on strategies that could be employed to encourage clinicians to use Ig judiciously such as clinical guidelines or audit and feedback mechanisms.