Evaluating medical resource utilization and costs associated with thrombocytopenia in chronic liver disease patients

Objective: Thrombocytopenia (TCP), defined as platelet counts <150,000/L, is a common complication of severe chronic liver disease (CLD). This retrospective study estimated the prevalence of thrombocytopenia in a large population of CLD patients and compared medical resource utilization and medical care costs by TCP status. Methods: A retrospective analysis was conducted on a longitudinal administrative claims database from a large US commercial health plan. Patients assigned CLD diagnosis codes from January 1, 2000December 31, 2003 were identified; annual ambulatory visits, ER visits, inpatient stays, and general and CLD-related medical care costs for patients with vs without TCP (identified using diagnosis codes and platelet count data if available) were compared. Results: Of 56,445 patients with an ICD-9-CM diagnosis for CLD, 1289 (2.3%) had a diagnosis for TCP. CLD patients with vs without a TCP diagnosis had >2.5-times the annual number of liver disease-related ambulatory visits (3.6 vs 1.4; odds ratio [OR]=2.6, p<0.01); were 13-times more likely to have a liver-related inpatient stay (OR=13.0, p<0.01); were nearly 4-times more likely to have a liver-related ER visit (OR=3.9, p<0.01); had 3.5-fold greater mean annual overall medical care costs ($$43,560 vs $$12,270, p<0.01); and had 7-fold greater annual liver disease-related medical care costs ($$9940 vs $$1420, p<0.01). Similar results were seen for patients with platelet count data indicating TCP. Limitations: CLD and TCP are not always diagnosed, nor is diagnosis uniform or standardized; administrative claims data are subject to coding errors, and individuals covered are not necessarily representative of the general US population. The number of CLD patients in this study with TCP (n=1289) is small relative to that expected in the general US population. Conclusions: In this analysis, CLD patients with TCP used significantly more medical resources and incurred significantly higher medical care costs than those without TCP.