Health care utilization of patients diagnosed with idiopathic thrombotic thrombocytopenic purpura in a commercially insured population in the United States.
BACKGROUND
Incident idiopathic thrombotic thrombocytopenic purpura (TTP) is an uncommon, potentially fatal blood disorder for which there are little or no data on health care costs.


METHODS
Patients satisfying a validated claims-based algorithm including an inpatient diagnosis of TTP and plasma exchange (PE) procedure during the period January 1, 2001 to May 31, 2008 were identified in the HealthCore Integrated Research Database. To characterize patterns of treatment and payments, a quantitative evaluation of comorbidities and treatments, health care utilization, and payments among this population of patients was conducted. All patients were followed until death, end of health plan enrollment, or 365 days after the TTP hospitalization, whichever occurred first.


RESULTS
One hundred fifty-one patients met the claims coding algorithm. Mean total health care payments for the TTP hospitalization were $56,347 (standard deviation [SD] $80,230). Ten patients (6.6%) died during the hospitalization for TTP. Mean payments for PE services in the month following discharge were $9127 (SD $20,840). Several patients required prolonged PE during the acute TTP phase (up to 116 separate exchanges over a period of 365 days), prolonging required treatment and skewing payments and resource utilization during the 365-day period following discharge from the index TTP hospitalization.


CONCLUSIONS
These data document the health care resource utilization by patients with idiopathic TTP, demonstrating that management of these patients is not only expensive but also skewed, with some patients requiring prolonged treatment. These data can contribute to cost-effectiveness models when new treatments for TTP become available.
HealthCore, Inc., Wilmington, Delaware, USA. pwahl@hsph.harvard.edu
Peter M
PM
Wahl
Rhonda L
RL
Bohn
Deirdra R
DR
Terrell
James N
JN
George
Bruce
B
Ewenstein
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003132:Commerce; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008329:Managed Care Programs / Q000191:economics; D008875:Middle Aged; D011153:Population; D011697:Purpura, Thrombotic Thrombocytopenic / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult