Hospitalizations in pediatric patients with immune thrombocytopenia in the United States

Abstract

To examine utilization and outcomes in pediatric immune thrombocytopenia (ITP) hospitalizations, we used ICD-9 code 287.31 to identify hospitalizations in patients with ITP in the 2009 HCUP KID, an all-payer sample of pediatric hospitalizations from US community hospitals. Diagnosis and procedure codes were used to estimate rates of ITP-related procedures, comorbidity prevalence, costs, length of stay (LOS), and mortality. In 2009, there were an estimated 4499 hospitalizations in children aged 6 months–17 years with ITP; 43% in children aged 1–5 years; and 47% with emergency department encounters. The mean hospitalization cost was $5398, mean LOS 2.0 days, with 0.3% mortality (n = 13). With any bleeding (15.2%, including gastrointestinal 2.0%, hematuria 1.3%, intracranial hemorrhage [ICH] 0.6%), mean hospitalization cost was $7215, LOS 2.5 days, with 1.5% mortality. For ICH (0.6%, n = 27), mean cost was $40 209, LOS 8.5 days, with 21% mortality. With infections (14%, including upper respiratory 5.2%, viral 4.9%, bacterial 1.9%), the mean cost was $6928, LOS 2.9 days, with 0.9% mortality. Septic shock was reported in 0.3% of discharges. Utilization included immunoglobulin administration (37%) and splenectomies (2.3%). Factors associated with higher costs included age >6 years, ICH, hematuria, transfusion, splenectomy, and bone marrow diagnostics (p < 0.05). In conclusion, of the 4499 hospitalizations with ITP, mortality rates of 1.5%, 21%, and 0.9% were seen with any bleeding, ICH, and infection, respectively. Higher costs were associated with clinically significant bleeding and procedures. Future analyses may reveal effects of the implementation of more recent ITP guidelines and use of additional treatments.

Keywords:

• Bleeding
• costs
• infection
• inpatient utilization
• KID
• outcomes

Acknowledgments

Susanna Mac, MD, PhD, of Amgen Inc. provided medical writing assistance. The authors made decisions regarding submission of the manuscript. M.D. and J.D. wrote the first draft.

Funding

Amgen Inc. funded these analyses, which were directed by the authors.

Declaration of interest statement

M.T. is an advisor for Baxalta, Biogen, Grifols, Novo Nordisk, and Pfizer; received research funding from Grifols and Novo Nordisk; is on the speakers’ bureau with Biogen and Grifols. M.D. and J.D. are consultants for and received research funding from Amgen Inc. as part of Outcomes Insights. R.K. received research funding support from Cangene Corp. and Novartis, Canada, and is an advisor for Celgene Corp. M.E. is an employee and stockholder of Amgen Inc. J.B. received research funding from Amgen Inc., Cangene, GlaxoSmithKline (GSK), Genzyme, IgG of America, Immunomedics, Ligand, Eisai, Shionogi, and Sysmex; is on advisory boards for Amgen Inc., GSK, Ligand, Shionogi, and Eisai; and is a consultant for Portola.

Additional information

Funding

Amgen Inc. funded these analyses, which were directed by the authors.