title: Cost of Bleeding-related Episodes in Adult Patients With Primary Immune Thrombocytopenia: A Population-based Retrospective Cohort Study of Administrative Claims Data for Commercial Payers in the United States.
abstract: OBJECTIVE
  We estimated the real-world costs of bleeding-related episodes (BREs) in adults with primary immune thrombocytopenia (ITP).
  
  
  METHODS
  This retrospective cohort study used the MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases. We identified adult patients diagnosed with primary ITP between 2007 and 2012, defined by at least 2 outpatient claims separated by ≥30 days or 1 inpatient claim (International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for primary ITP [287.31]). BRE was defined according to a combination of diagnosis codes and/or procedure codes indicating bleeding or use of rescue therapies. Costs were estimated using total reimbursed amount received by providers (including out-of-pocket costs and reimbursement from insurance, adjusted to 2015 US dollars).
  
  
  RESULTS
  In 6551 patients, 14,115 BREs were identified, mean (SD) age was 55 (18) years, and 62% of patients were women. Mean total reimbursement per BRE was $6022, with significantly higher mean inpatient ($45,114) versus outpatient ($2150) reimbursements (P < 0.0001). Mean BRE reimbursements were higher in splenectomized patients compared with nonsplenectomized patients ($8365 vs $5858); however, the difference was not statistically significant. Mean reimbursement for BREs associated with bleeding alone was $10,396, and with rescue therapy alone it was $2787. Reimbursement for BREs that included both bleeding and rescue therapy was $11,065.
  
  
  CONCLUSIONS
  The real-world reimbursement rates of BREs in adult patients with primary ITP can be substantial, with significantly higher values among patients requiring hospitalization and for those with bleeding events. Additionally, there is a trend toward higher reimbursement rates among splenectomized patients.
authors.affiliation: Amgen Inc, Thousand Oaks, California.
authors.forename: Junji
authors.initials: J
authors.lastname: Lin
authors.affiliation: Amgen Inc, Thousand Oaks, California; University of Southern California, Los Angeles, California.
authors.forename: Xinke
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Amgen Inc, Thousand Oaks, California.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Li
authors.affiliation: Amgen Inc, Thousand Oaks, California. Electronic address: dchandle@amgen.com.
authors.forename: David
authors.initials: D
authors.lastname: Chandler
authors.affiliation: Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Ivy
authors.initials: I
authors.lastname: Altomare
authors.affiliation: Carole and Ray Neag Comprehensive Cancer Center, University of Connecticut School of Medicine, Farmington, Connecticut; Department of Medicine, Division of Hematology-Oncology, University of Connecticut School of Medicine, Farmington, Connecticut.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Wasser
authors.affiliation: Amgen Inc, Cambridge, Massachusetts.
authors.forename: Karynsa
authors.initials: K
authors.lastname: Cetin
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D005260:Female; D005102:Health Expenditures; D006470:Hemorrhage / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D006278:Medicare; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000191:economics*; D012189:Retrospective Studies; D014481:United States
keywords: bleeding events; cost analysis; hemorrhage; immune thrombocytopenia