title: Treatment, outcome, and cost of care in children with idiopathic thrombocytopenic purpura.
abstract: Data were reviewed on treatment patterns, outcome, and hospital charges for children with idiopathic thrombocytopenic purpura (ITP). Records of 186 children with ITP, seen between January 1997 and April 2001, were reviewed. Hospital charges for initial management and first re-treatment were calculated by combining physician, hospital, and pathology charges. Anti-D immune globulin [anti-D IG] was used in 32.3%, intravenous immune globulin [IVIG] in 22.6%, steroids in 22.6%, combination therapies in 8%, and 14.5% were observed. Two patients had CNS bleeding, one with intraventricular hemorrhage at diagnosis, and the other with a parietal bleed 1 year from diagnosis. There was no significant differences in time to reach platelet counts of 20, 50, or 150 (x 10(9)/L) across different treatment groups. There was no significant difference in median charges for the IVIG and anti-D IG groups for the initial treatment of ITP. However, the IVIG was significantly more expensive than steroids or observation. Charges for the anti-D IG group were higher than the observation group but not the steroid group. After drug charges were excluded, patients in the IVIG group had statistically higher charges compared to patients in anti-D IG group. Almost half the patients were re-treated. There was no significant difference between anti-D IG, IVIG, and steroid groups when initial and re-treatment charges were combined. The observation group remained least expensive. Outcome for children with ITP is similar regardless of initial management. There is not a statistically significant difference in hospital charges between patients treated with anti-D IG and IVIG. The IVIG-treated group tends to be more costly, but this is not due to drug charges. Re-treatment is common and decreases the difference in patient charges among initial therapies.
authors.affiliation: Department of Pediatrics, Section of Hematology/Oncology James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA. mkumar@iupui.edu
authors.forename: Manjusha
authors.initials: M
authors.lastname: Kumar
authors.forename: Terry A
authors.initials: TA
authors.lastname: Vik
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Johnson
authors.forename: M Elaine
authors.initials: ME
authors.lastname: Southwood
authors.forename: James M
authors.initials: JM
authors.lastname: Croop
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005249:Fees and Charges; D005252:Fees, Pharmaceutical; D005260:Female; D017722:Hospital Charges; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D012189:Retrospective Studies; D018029:Rho(D) Immune Globulin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D013256:Steroids / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous; D018029:Rho(D) Immune Globulin; D013256:Steroids