OBJECTIVES: Few data exist on comparative costs between splenectomized and non-splenectomized ITP patients. The objective of this study was to estimate, with a 6 to 9-year time horizon, the average hospital cost of splenectomized ITP patients including the surgical procedure and their follow-up in comparison with the average hospital cost of non-splenectomized ITP patients.

METHODS: A PMSI data analysis was performed on 4 cohorts of incident ITP patients in lag (2007 to 2010 until 2015), with or without splenectomy. Hospital stays were selected with the ICD10 code D69.3 in position of: Principal Diagnosis (PD) or Related Diagnosis (RD) or Associated Diagnosis with selected ICD10 codes in PD/RD related to hemorrhage, thrombosis and infection. The list of codes was selected by French clinicians. An incident ITP patient was defined as any patient who had never had an ICD10 code "D69.3" on the calendar year preceding the inclusion. Hospital stays with at least one of the 2 CCAM codes for splenectomy (FFFC001 "Total splenectomy by laparoscopy", FFFA001 "Total splenectomy by laparotomy") were extracted. For each stay, a disease related group (DRG) cost (€, 2016) was calculated according to the French health service perspective. Costs of extra-DRG drugs were not accounted for.

RESULTS: The incidence of ITP was stable over time with 3,600-3,900 patients/year. The incident number of hospital stays for ITP was also stable over time (12,000-14,000 stays). The number of splenectomized patients has decreased by 37% since 2007 (152 patients were splenectomized in 2015 vs. 241 in 2007). The average hospital cost of ITP patients varied from 13,428€ to 14,446€ per splenectomized patient and from 3,459€ to 3,599€ per non-splenectomized patient.

CONCLUSIONS: This study suggests that hospitalization costs for hemorrhage, thrombosis and infection are higher in the group of splenectomized patients. A cost-effectiveness analysis from a broader perspective (in and out patients) should be conducted.