TY - JOUR
T1 - The burden associated with thrombocytopenia and platelet transfusions among patients with chronic liver disease
AU - Elsaid, Mohamed I.
AU - Rustgi, Vinod K.
AU - Loo, Nicole
AU - Aggarwal, Kavita
AU - Li-McLeod, Josephine
AU - Niu, Xiaoli
AU - Poordad, Fred
N1 - Publisher Copyright:
© 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2020/4/2
Y1 - 2020/4/2
N2 - Background: Thrombocytopenia (TCP), a common complication of chronic liver disease (CLD), can cause uncontrolled bleeding during procedures. As such, CLD patients with TCP and platelet counts <50,000/μL often receive prophylactic platelet transfusions before invasive procedures. However, platelet transfusions are associated with clinical complications, which may result in increased healthcare utilization and costs. Objective: This retrospective database analysis describes the clinical and economic burden in CLD patients with TCP, CLD patients without TCP, and CLD patients with TCP who receive platelet transfusions. Methods: Adult CLD patients with or without TCP were identified in the IBM MarketScan Commercial Claims and Medicare Supplemental data from 1 January 2012 to 31 December 2015. CLD patients with or without TCP were propensity-score matched (1:1) for the analysis of annual healthcare utilization and costs. Platelet transfusions among CLD patients with TCP were identified using procedure codes. Results: Of the 601,626 patients with CLD, 8,292 (1.4%) patients with TCP were matched to patients without TCP. Among CLD patients with TCP, 981 (11.8%) patients received ≥1 platelet transfusions and met inclusion/exclusion criteria. Compared to patients without TCP, CLD patients with TCP had more complications, including higher prevalence of neutropenia (11.4% vs 2.9%) and bleeding events (21.4% vs 10.9%), greater resource utilization including greater average hospital admissions (1.2 vs 0.7, p <.01), greater average ER visits (2.1 vs 1.3, p <.01), higher average outpatient office visits (20.1 vs 18.4, p <.01), and higher average healthcare costs including total costs (p <.01), inpatient costs (p <.01), ER visit costs (p <.01), and outpatient office visit costs (p <.01). The mean annual total costs in CLD and TCP patients with platelet transfusions were $206,396. Conclusions: CLD patients with TCP, and particularly those who received platelet transfusions, experienced significantly greater clinical and economic burden compared to CLD patients without TCP. Safer and more cost-effective treatments to increase platelets are necessary.
AB - Background: Thrombocytopenia (TCP), a common complication of chronic liver disease (CLD), can cause uncontrolled bleeding during procedures. As such, CLD patients with TCP and platelet counts <50,000/μL often receive prophylactic platelet transfusions before invasive procedures. However, platelet transfusions are associated with clinical complications, which may result in increased healthcare utilization and costs. Objective: This retrospective database analysis describes the clinical and economic burden in CLD patients with TCP, CLD patients without TCP, and CLD patients with TCP who receive platelet transfusions. Methods: Adult CLD patients with or without TCP were identified in the IBM MarketScan Commercial Claims and Medicare Supplemental data from 1 January 2012 to 31 December 2015. CLD patients with or without TCP were propensity-score matched (1:1) for the analysis of annual healthcare utilization and costs. Platelet transfusions among CLD patients with TCP were identified using procedure codes. Results: Of the 601,626 patients with CLD, 8,292 (1.4%) patients with TCP were matched to patients without TCP. Among CLD patients with TCP, 981 (11.8%) patients received ≥1 platelet transfusions and met inclusion/exclusion criteria. Compared to patients without TCP, CLD patients with TCP had more complications, including higher prevalence of neutropenia (11.4% vs 2.9%) and bleeding events (21.4% vs 10.9%), greater resource utilization including greater average hospital admissions (1.2 vs 0.7, p <.01), greater average ER visits (2.1 vs 1.3, p <.01), higher average outpatient office visits (20.1 vs 18.4, p <.01), and higher average healthcare costs including total costs (p <.01), inpatient costs (p <.01), ER visit costs (p <.01), and outpatient office visit costs (p <.01). The mean annual total costs in CLD and TCP patients with platelet transfusions were $206,396. Conclusions: CLD patients with TCP, and particularly those who received platelet transfusions, experienced significantly greater clinical and economic burden compared to CLD patients without TCP. Safer and more cost-effective treatments to increase platelets are necessary.
KW - Chronic liver disease
KW - healthcare cost
KW - healthcare utilization
KW - platelet transfusion
KW - thrombocytopenia
UR - http://www.scopus.com/inward/record.url?scp=85076910897&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85076910897&partnerID=8YFLogxK
U2 - 10.1080/13696998.2019.1699563
DO - 10.1080/13696998.2019.1699563
M3 - Article
C2 - 31777291
AN - SCOPUS:85076910897
SN - 1369-6998
VL - 23
SP - 378
EP - 385
JO - Journal of Medical Economics
JF - Journal of Medical Economics
IS - 4
ER -