Primary immune thrombocytopenia in US clinical practice: incidence and healthcare burden in first 12 months following diagnosis

Abstract

Introduction: Primary immune thrombocytopenia (ITP), an autoimmune disorder characterized by low platelet count, can lead to serious bleeding events. Little is known about the current epidemiology of ITP in the US, and even less is known about the current healthcare burden of ITP, especially in the 12-month period following ITP diagnosis. Method: We used a retrospective cohort design and data from two US private healthcare claims databases (2010)(2011)(2012)(2013)(2014)(2015)(2016) to identify persons with evidence of newly diagnosed ITP. We weighted estimates of the annual incidence of ITP by age and sex to reflect the US population, and summarized healthcare utilization and expenditures (2016 US$) during the first 12 months after ITP diagnosis ("followup period"). Results: Annual incidence of ITP in the US was 6.1 per 100,000 persons, higher among females versus males (6.7 vs. 5.5), and highest among children aged 0-4 years (8.1) and adults aged !65 years (13.7). Patients with ITP averaged 0.33 (95% CI: 0.32-0.35) hospitalizations and 15.3 (15.1-15.6) ambulatory encounters during the follow-up period; mean total healthcare expenditures during this period were $21,290 (20,502-22,031). Hospitalizations were more common during the first 3 months following diagnosis, and were twice as frequent among children versus adults; expenditures for ambulatory encounters were substantially higher for adults versus children aged 0-4 years. Conclusions: Our findings suggest that nearly 20,000 children and adults are newly diagnosed with ITP each year in the US, substantially higher than previously reported. Among patients requiring formal medical care, the economic burden during the first 12 months following diagnosis is high, with estimated US expenditures totaling over $400 million.

Second‐line treatments and outcomes for immune thrombocytopenia: A retrospective study with electronic health records

“…Recent estimates from US health care claims databases (2010-2016) found an annual incidence of ITP of 6.1 per 100 000 people. 1 New ITP diagnoses occur in nearly 20 000 children and adults each year in the United States, with collective medical care costs of more than $400 million within the first 12 months after diagnosis. 1 Corticosteroids and intravenous immune globulin (IVIG) are the most commonly used first-line treatments; splenectomy, rituximab, and thrombopoietin receptor agonists (TPO-RAs) are all acceptable second-line options.…”

“…1 New ITP diagnoses occur in nearly 20 000 children and adults each year in the United States, with collective medical care costs of more than $400 million within the first 12 months after diagnosis. 1 Corticosteroids and intravenous immune globulin (IVIG) are the most commonly used first-line treatments; splenectomy, rituximab, and thrombopoietin receptor agonists (TPO-RAs) are all acceptable second-line options. 2,3 TPO-RAs, including eltrombopag, romiplostim, and avatrombopag, now provide an alternative option among patients for whom second-line therapy is indicated.…”

“…Immune thrombocytopenia (ITP) involves the immune‐mediated destruction of platelets and suppression of platelet production, leading to an increased risk of bleeding events. Recent estimates from US health care claims databases (2010‐2016) found an annual incidence of ITP of 6.1 per 100 000 people 1 . New ITP diagnoses occur in nearly 20 000 children and adults each year in the United States, with collective medical care costs of more than $400 million within the first 12 months after diagnosis 1 …”

Incidence and prevalence of immune thrombocytopenia under the copayment waiver policy for pediatric patients in Korea: Data from the National Health Claims Database

“…Compared to population-based pediatric studies in other countries, the prevalence in this study was higher than in the USA (4.1–13.6 per 100,000 persons). 5,10 The incidence was also higher than in USA and western countries (2.8–8.8 per 100,000 persons), 8,11,15 and in Asian country, Taiwan (4.0 per 100,000 persons). 6 An earlier Korean study showed similar results (14.3 per 100,000 persons).…”

“…Although previous nationwide population-based or cohort studies of ITP demonstrated higher rates in children than adults, ITP data was often only reported on indirectly as a subset of adult ITP epidemiological data, and categorized by age based on 5- or 10-year intervals. 5–12…”