Department of Hematology and.
Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT.
Blood Adv. 2020 Feb 11;4(3):539-545. doi: 10.1182/bloodadvances.2019000827.
Patients with severe autoimmune thrombotic thrombocytopenic purpura (TTP) experience acute hematologic emergencies during disease flares and a lifelong threat for relapse. Rituximab, in addition to steroids and therapeutic plasma exchange (TPE), has been shown to mitigate relapse risk. A barrier to care in initiating rituximab in the inpatient setting has been the presumed excessive cost of medication to the hospital. Retrospectively reviewing TTP admissions from 2004 to 2018 at our academic center, we calculated the actual inpatient cost of care. We then calculated the theoretical cost to the hospital of initiating rituximab in the inpatient setting for both initial TTP and relapse TTP cohorts, with the hypothesis that preventing sufficient future TTP admissions offsets the cost of initiating rituximab in all patients with TTP. At a median follow-up of 55 months in the initial TTP cohort, rituximab use produced a projected cost savings of $905 906 and would have prevented 185 inpatient admission days and saved 137 TPE procedures. In the relapse TTP setting, rituximab use produced a projected cost savings of $425 736 and would have prevented 86 inpatient admission days and saved 64 TPE procedures. From a hospital cost standpoint, cost of rituximab should no longer be a barrier to initiating inpatient rituximab in both initial and relapse TTP settings.
患有严重自身免疫性血栓性血小板减少性紫癜（TTP）的患者在疾病发作期间会经历急性血液学急症，并且终生存在复发的威胁。利妥昔单抗除了类固醇和治疗性血浆置换（TPE）外，还被证明可以降低复发风险。在住院环境中启动利妥昔单抗治疗的障碍之一是医院认为药物费用过高。我们回顾了 2004 年至 2018 年在我们学术中心的 TTP 住院患者，计算了实际的住院护理成本。然后，我们计算了在住院环境中启动利妥昔单抗治疗的理论医院成本，假设预防足够多的未来 TTP 住院可以抵消所有 TTP 患者启动利妥昔单抗的成本。在初始 TTP 队列的中位随访 55 个月时，利妥昔单抗的使用预计将节省 905906 美元，并将预防 185 天的住院治疗和 137 次 TPE 治疗。在复发 TTP 情况下，利妥昔单抗的使用预计将节省 425736 美元，并将预防 86 天的住院治疗和 64 次 TPE 治疗。从医院成本的角度来看，利妥昔单抗的成本不应再成为启动初始和复发 TTP 患者住院利妥昔单抗治疗的障碍。
