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International Journal of Hematology

, Volume 107, Issue 1, pp 75–82 | Cite as

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

  • Yusuke Okubo
  • Nobuaki Michihata
  • Naho Morisaki
  • Mayumi Hangai
  • Hiroki Matsui
  • Kiyohide Fushimi
  • Hideo Yasunaga
Original Article

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% (P trend < 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 (P trend < 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.

Keywords

Immune thrombocytopenia Children Corticosteroid Immunoglobulin Inverse probability weighting 

Notes

Compliance with ethical standards

Funding source

This work was supported by Grants from the Ministry of Health, Labour and Welfare, Japan; Ministry of Education, Culture, Sports, Science and Technology, Japan; and the Japan Agency for Medical Research and Development.

Conflict of interest

The authors have no financial relationships and no conflict of interest relevant to this article to disclose.

Supplementary material

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Supplementary material 1 (DOC 34 kb)
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Supplementary material 2 (TIFF 5744 kb)
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Supplementary material 3 (DOC 31 kb)
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Supplementary material 4 (DOC 34 kb)

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Copyright information

© The Japanese Society of Hematology 2017

Authors and Affiliations

  1. 1.Department of EpidemiologyUCLA Fielding School of Public HealthLos AngelesUSA
  2. 2.Department of Social MedicineNational Center for Child Health and DevelopmentTokyoJapan
  3. 3.Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoTokyoJapan
  4. 4.Department of Health Services Research, Graduate School of MedicineThe University of TokyoTokyoJapan
  5. 5.Department of PediatricsThe University of TokyoTokyoJapan
  6. 6.Department of Health Policy and InformaticsTokyo Medical and Dental University Graduate School of MedicineTokyoJapan

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