Analysis of the impact and burden of illness of adult chronic ITP in the US

Objective: Chronic idiopathic thrombocytopenic purpura (ITP), the predominant diagnosis in the ICD-9-CM category of primary thrombocytopenia in adults, is an autoimmune disease characterized by autoantibody-mediated platelet destruction and reduced platelet production. The objective of this study was to describe ITP patient demographics, treatment, medical care resource utilization, and costs from a real-world situation. Research design and methods: Managed-care administrative claims data from January 1 2000 to February 29 2004 were used in a retrospective, longitudinal cohort study to evaluate the burden of illness of chronic idiopathic primary thrombocytopenia among adults in the US, with particular emphasis on chronic ITP. Results: The annual prevalence of chronic, non-secondary, idiopathic thrombocytopenia in adults (out of45.5 million patients) was 0.08% (i.e., 80 persons in 100 000). The mean age of the total cohort was 56.5 years (men, 60.2; women, 53.3); ratio of women to men was 1.1:1. The most frequently used thrombocytopeniaassociated treatments were pharmacological therapy (e.g., immunoglobulins and corticosteroids) and whole blood transfusions; frequently used concomitant medications were antibiotics, antihypertensive agents, analgesics, and antidepressants. These data indicate that idiopathic thrombocytopenia-associated medical resource utilization and the corresponding expenditures for those services were substantive and constant over time. A large proportion of the overall patient care was directed to the treatment of bleeding and bruising symptoms. Although hospital and ER use was infrequent, these services accounted for the majority of ITP-attributable costs (46.1% were attributable to ITP-related hospital admissions; 45.0% were attributable to ER services for ITP). Conclusions: There is a need for patient-directed care plans, fuller consideration of available treatments, and the potential reduction in patient burden of illness. Study limitations included a broadly defined cohort and possible underreporting of certain medications. Introduction of highly effective and well-tolerated medications may reduce the cost and resource burden of ITP on the healthcare system.