title: Intravenous Immunoglobulin (IVIg) Utilization in Immune Thrombocytopenia (ITP): A Multi-Center, Retrospective Review.
abstract: BACKGROUND
  Intravenous immunoglobulin (IVIg) is an immune thrombocytopenia (ITP) therapy, which is associated with toxicities, limited availability, increasing utilization, and high cost. This study aimed to assess short- and long-term IVIg utilization in patients with ITP at two tertiary care centers in Ontario, Canada, to determine the proportion of IVIg used in ITP compared with all usage, and to forecast IVIg demand in ITP.
  
  
  METHODS
  Records from all adult ITP patients who received IVIg between January 1, 2003, and September 30, 2012, at Hamilton Health Sciences and London Health Sciences Centre were reviewed retrospectively.
  
  
  RESULTS
  During the study period, 383 adult ITP patients (mean age 51.3 years) received a total of 2,098 IVIg infusions (London 547 infusions in 150 patients; Hamilton 1,551 infusions in 233 patients). ITP accounted for 5.6 and 9.1 % of all IVIg usage in London and Hamilton, respectively. The treatments included 264 (53.7 %) acute, 172 (35.0 %) short-term, and 56 (11.4 %) long-term treatments. The amounts of IVIg used for short- and long-term treatment of ITP are forecasted to be approximately 5,000 and 11,000 g per year, respectively, up to 2018. Together, these two centers represent 19.9 % of the provincial IVIg utilization. Assuming similar patient populations and practice patterns in Ontario, the overall provincial cost of IVIg use in ITP may be as high as $5 million annually.
  
  
  CONCLUSIONS
  Short- and long-term IVIg utilization for ITP will remain an expensive resource within the Ontario provincial health care system. Physicians and policy makers should reflect on the impact of treating ITP with IVIg and should consider alternatives, where appropriate, to improve patient quality of life and decrease economic costs.
authors.affiliation: London Health Sciences Centre, London, ON, Canada. cyrus.hsia@lhsc.on.ca.|Division of Hematology, Department of Medicine, London Health Sciences Centre, Room E6-219, Victoria Hospital, 800 Commissioners Road East, London, ON, N6A 4G5, Canada. cyrus.hsia@lhsc.on.ca.
authors.forename: Cyrus C
authors.initials: CC
authors.lastname: Hsia
authors.affiliation: Department of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: London Health Sciences Centre, London, ON, Canada.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Eckert
authors.affiliation: GlaxoSmithKline Inc., Mississauga, ON, Canada.
authors.forename: Neerav
authors.initials: N
authors.lastname: Monga
authors.affiliation: GlaxoSmithKline Inc., Mississauga, ON, Canada.
authors.forename: Julia
authors.initials: J
authors.lastname: Elia-Pacitti
authors.affiliation: Department of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Heddle