International Journal of Hematology

DOI: 10.1007/s12185-017-2322-1 Pages: 75-82

Recent trends in practice patterns and comparisons between immunoglobulin and corticosteroid in pediatric immune thrombocytopenia

1. UCLA Fielding School of Public Health, Department of Epidemiology

2. National Center for Child Health and Development, Department of Social Medicine

3. The University of Tokyo, Department of Clinical Epidemiology and Health Economics, School of Public Health

4. The University of Tokyo, Department of Health Services Research, Graduate School of Medicine

5. The University of Tokyo, Department of Pediatrics

6. Tokyo Medical and Dental University Graduate School of Medicine, Department of Health Policy and Informatics

Correspondence to:
Yusuke Okubo
Tel: +81-3-3416-0181
Email: sunning_dale@yahoo.co.jp

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Abstract

The clinical benefits and practice patterns of different pharmacologic regimes in acute pediatric immune thrombocytopenia (ITP) remain unclear in Japan. Using a national inpatient database, we analyzed recent trends in practice patterns for acute pediatric ITP, and compared risks of 6-month readmission, total hospitalization costs, and lengths of hospital stay between ITP children treated with intravenous immunoglobulin (IVIG) and corticosteroid, using inverse probability weighting analyses. From 2010 to 2014, the proportions of IVIG use increased from 43.4 to 66.0% (Ptrend < 0.001), while the proportions of corticosteroid use and watchful waiting decreased from 16.4 to 10% and from 28.6 to 14.3%, respectively (Ptrend < 0.001). No significant difference in 6-month readmission risk was observed between IVIG and corticosteroid (p = 0.28). Total length of hospital stay in the corticosteroid group was 3.5 days longer than that in IVIG (95% confidence interval, 2.1–4.6 days), whereas total hospitalization cost was greater in IVIG than in corticosteroid (difference, ¥ 207,994; 95% confidence interval, ¥ 149586–¥ 280728). A trend toward increased IVIG use was observed during the study period. Total hospitalization cost was considerably greater in the IVIG than in the corticosteroid group, whereas readmission risks were similar in both groups.

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