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

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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% (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.

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Authors and Affiliations

  1. Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, USA

    Yusuke Okubo

  2. Department of Social Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 1578535, Japan

    Yusuke Okubo, Naho Morisaki & Mayumi Hangai

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

    Yusuke Okubo, Hiroki Matsui & Hideo Yasunaga

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

    Nobuaki Michihata

  5. Department of Pediatrics, The University of Tokyo, Tokyo, Japan

    Mayumi Hangai

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

    Kiyohide Fushimi

Authors
  1. Yusuke Okubo
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  2. Nobuaki Michihata
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  3. Naho Morisaki
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  4. Mayumi Hangai
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  5. Hiroki Matsui
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  6. Kiyohide Fushimi
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  7. Hideo Yasunaga
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Corresponding author

Correspondence to Yusuke Okubo.

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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.

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

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Okubo, Y., Michihata, N., Morisaki, N. et al. Recent trends in practice patterns and comparisons between immunoglobulin and corticosteroid in pediatric immune thrombocytopenia. Int J Hematol 107, 75–82 (2018). https://doi.org/10.1007/s12185-017-2322-1

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  • DOI: https://doi.org/10.1007/s12185-017-2322-1

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