Table 2.

Comparative summary of selected costs, advantages, disadvantages, and side effects of the therapeutic plasma exchange, steroids, rituximab, and caplacizumab. Legend: CMS = Centers for Medicare and Medicaid Services; mg = milligram.

Therapies	Therapeutic Plasma Exchange (TPE)	Steroids	Rituximab	Caplacizumab
Cost per CMS unit	Average cost per 1 TPE session: USD 4900 Cost range: USD 3000–USD 6600 [56,60,63,64]	USD 0.02/mg of prednisone [65] USD 5.95/125 mg of methylprednisone [65]	USD 81.75 per 10 mg [65]	USD 718.64 per mg [65]
Advantages	Total of 30 years of data, Lifesaving [11]	Globally available, low cost	Total of 20 years of data; associated with increased time to relapse [66] in the short-run; can be cost-saving to hospitals in the long-run [46]	Easy administration, associated with decreased exacerbations [3]
Disadvantages	Requires logistical coordination; not available at all hospitals	Need to minimize unnecessary patient steroid exposure (i.e., overly prolonged tapers)	Recent observational study reporting differential effect of the social construct of race on relapse-free survival [41]	Associated with longer time to ADAMTS13 recovery [67], increased relapses [3], increased major bleeding [19], high cost [19]
Side Effects	Fever, urticaria, and hypocalcemic symptoms [68]	Immunosuppression leading to increased risk of infections; osteoporosis, myopathy, increase in blood glucose levels, weight gain, hypertension, arrhythmias, skin atrophy, acne, mild hirsutism, stria, impaired wound healing [69]	Immunosuppression leading to increased risk of infections; rituximab hypersensitivity; serum sickness and exacerbation of cardiac symptoms [42]	Bleeding (Table 1) [19]