Hospitalizations in pediatric patients with immune thrombocytopenia in the United States

Figures & data

Table I. Estimated bleeding and infection hospitalizations in patients with ITP.

Factor	n (%)	95% CI		LOS	95% CI		Cost	95% CI		Mortality
Bleeding outcomes
Nonbleeding	3813 (85%)	3365	4261	1.9	1.8	1.9	$5122	$4785	$5482	0.07%
All bleeding	686 (15.2%)	583	789	2.5	2.3	2.7	$7215	$6355	$8192	1.5%
ICH	27 (0.6%)	12	42	8.5	4.2	17.4	$40 209	$23 323	$69 286	20.8%
Upper or lower GI bleeding	20 (0.4%)	8	31	2.9	2.0	4.2	$12 520	$7871	$19 916	0.00%
Other GI bleeding	74 (1.6%)	52	97	2.7	2.1	3.4	$7421	$5562	$9902	1.95%
Hematuria	60 (1.3%)	39	80	3.2	2.5	4.2	$10 750	$7686	$15 033	2.65%
Female specific	NA	NA	NA	2.8	1.3	6.0	$11 801	$3793	$36 717	0.00%
Infection outcomes
Noninfected	3849 (86%)	3395	4302	1.8	1.8	1.9	$5175	$4817	$5559	0.19%
Any infection	650 (14%)	557	743	2.9	2.6	3.2	$6928	$6144	$7813	0.90%
URI	234 (5.2%)	190	277	2.2	2.0	2.5	$5592	$4820	$6489	0.00%
Skin/SC	54 (1.2%)	34	74	3.7	2.6	5.4	$9134	$5835	$14 300	0.00%
Mycoses^a	19 (0.4%)	8	29	4.0	2.2	7.3	$8276	$4212	$16 269	0.00%
Septicemia	45 (1.0%)	27	63	10.2	6.7	15.3	$26 077	$15 429	$44 091	9.59%
Septic shock	12 (0.3%)	4	20	6.6	3.6	12.0	$22 825	$9653	$54 014	11.11%
Viral, NEC	221 (4.9%)	179	262	2.5	2.2	2.9	$5987	$5081	$7054	0.00%
Bacterial, NEC	87 (1.9%)	63	110	4.8	3.6	6.4	$10 824	$7640	$15 337	0.00%

^aPrimarily dermatophytosis and candidiasis.

Costs calculated from charges by using hospital-specific CCRs where available; mortality based on discharge status.

CCR, cost-to-charge ratio; CI, confidence interval; GI, gastrointestinal; ICH, intracranial haemorrhage; ITP, immune thrombocytopenia; NA, not available; LOS, length of stay; NEC, not elsewhere classified; SC, subcutaneous; URI, upper respiratory infection.

Table II. Other utilization.

Factor	n (%)	95% CI		LOS	95% CI		Costs	95% CI		Mortality
Ig infusion	1686 (37%)	1389	1982	1.9	1.8	1.9	$6107	$5480	$6806	0.17%
Anti-D	111 (2.5%)	69	153	1.9	1.7	2.2	$4161	$3415	$5070	0.00%
IVIg	1582 (35%)	1299	1866	1.9	1.8	2.0	$6275	$5612	$7016	0.18%
IV corticosteroids	29 (0.6%)	12	46	3.7	1.8	7.6	$9590	$4085	$22 516	4.99%
Splenectomy	105 (2.3%)	77	133	3.1	2.5	3.8	$14 595	$12 076	$17 641	0.00%
BM diagnostics	330 (7.3%)	251	409	4.0	3.5	4.6	$12 172	$10 615	$13 961	0.92%
ED services	2095 (47%)	1801	2389	2.0	1.9	2.1	$5658	$5258	$6089	0.47%
Transfusions	337 (7.5%)	276	399	4.0	3.5	4.6	$11 929	$10 239	$13 891	2.95%

Costs calculated from charges by using hospital-specific CCRs where available; mortality based on discharge status; transfusions include all transfusion types, including platelet transfusions.

BM, bone marrow; CCR, cost-to-charge ratio; CI, confidence interval; ED, emergency department; Ig, immunoglobulin; IV, intravenous; IVIg, intravenous Ig; LOS, length of stay.

Figure 1. Mean ITP hospitalization costs by (A) demographic characteristics of sex and age, (B) whether various complications occurred, (C) whether various treatments were given or interventions were performed, and (D) multivariate analysis, with incremental costs shown for factors significantly (p < 0.05) associated with higher costs. BM, bone marrow; ED, emergency department; GI, gastrointestinal; ICH, intracranial hemorrhage; Ig, immunoglobulin; ITP, immune thrombocytopenia; IVIg, intravenous Ig; m, month; y, year; NA, not available; splenect, splenectomy.

Table III. Factors associated with hospitalization cost.

Factor	Incremental cost	95% CI		p value
Intercept	$3912	$2632	$5192	<0.0001
Age 6–9 years	$2415	$1155	$3676	0.000
Age 10–13 years	$6553	$3576	$9530	<0.0001
Age 14–17 years	$6427	$4425	$8429	<0.0001
Girl	($60)	($1457)	$1338	0.933
ED admission	($526)	($2011)	$959	0.488
Septic shock	$45 663	($23 804)	$115 131	0.198
Ig infusion	$1629	($398)	$3656	0.115
ICH	$50 328	$20 605	$80 051	0.001
Any GI bleeding	$2164	($1719)	$6047	0.275
Hematuria	$9939	$234	$19 643	0.045
Transfusion	$6265	$2245	$10 285	0.002
Total splenectomy	$9560	$4411	$14 710	0.000
Bone marrow diagnostics	$10 866	$5453	$16 279	<0.0001

Incremental cost shows the independent effect of each factor on the total hospitalization costs.

Parentheses indicate negative costs.

The intercept reflects the cost for a boy aged 6 months to 5 years who was not admitted through the ED and who had no other factors during his hospitalization.

CI, confidence interval; ED, emergency department; GI, gastrointestinal; ICH, intracranial haemorrhage; Ig, immunoglobulin.