A cost-utility analysis of treatment for acute childhood idiopathic thrombocytopenic purpura (ITP)

Pediatr Blood Cancer. 2007 Feb;48(2):173-80. doi: 10.1002/pbc.20830.

Abstract

Background: The primary objective in the treatment of acute pediatric idiopathic thrombocytopenic purpura (ITP) is to rapidly increase the platelet count.

Methods: We built a decision analytic model to evaluate the cost-utility of four commonly used treatment strategies: intravenous immunoglobulin G (IVIG) 0.8 g/kg, anti-D 75 mcg/kg, methylprednisolone (30 mg/kg for 3 days), and prednisone (4 mg/kg/day for 4 days). In our baseline model, all children were hospitalized upon presentation, and discharged once the platelet count reached > or =20,000. We performed a literature search to estimate time to platelet count > or =20,000 for each strategy, as well as the probability of side effects. We obtained cost data and quality of life measures from institutional and published data sources.

Results: Total cost of one-time treatment for a 20 kg child was US dollars 786 with prednisone, US dollars 1,346 with methylprednisolone, US dollars 2,035 with anti-D, and US dollars 2,492 with IVIG. The strategies of IVIG and methylprednisolone were less effective and more expensive than anti-D and prednisone, respectively. Although anti-D caused the most rapid rise in platelet counts, the incremental cost-utility ratio (costs incurred by using anti-D instead of prednisone divided by health benefit of using anti-D instead of prednisone) was US dollars 7,616 per day of severe thrombocytopenia avoided, primarily due to the much higher medication cost of anti-D. Utilizing an outpatient model, the cost difference between anti-D and prednisone was even more striking.

Conclusions: The clinical benefit of anti-D is offset by a substantial cost increase. Although often overlooked in favor of newer agents, a brief course of high-dose prednisone is an inexpensive and effective treatment for acute ITP.

Publication types

  • Comparative Study

MeSH terms

  • Acute Disease
  • Child
  • Costs and Cost Analysis
  • Decision Support Techniques
  • Humans
  • Immunoglobulins, Intravenous / economics
  • Immunoglobulins, Intravenous / therapeutic use*
  • Isoantibodies / economics
  • Isoantibodies / therapeutic use*
  • Methylprednisolone / economics
  • Methylprednisolone / therapeutic use*
  • Platelet Count
  • Prednisone / economics
  • Prednisone / therapeutic use*
  • Purpura, Thrombocytopenic, Idiopathic / drug therapy*
  • Purpura, Thrombocytopenic, Idiopathic / economics
  • Quality of Life
  • Rho(D) Immune Globulin
  • Sensitivity and Specificity

Substances

  • Immunoglobulins, Intravenous
  • Isoantibodies
  • RHO(D) antibody
  • Rho(D) Immune Globulin
  • Prednisone
  • Methylprednisolone